Provider Demographics
NPI:1932281789
Name:ALBANESE, MICHAEL JOHN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:ALBANESE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3960 STILLMAN PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4197
Mailing Address - Country:US
Mailing Address - Phone:804-290-4414
Mailing Address - Fax:804-290-4416
Practice Address - Street 1:3960 STILLMAN PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4197
Practice Address - Country:US
Practice Address - Phone:804-290-4414
Practice Address - Fax:804-290-4416
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001721111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA140520OtherBC/BS
VAV65014Medicare UPIN