Provider Demographics
NPI:1942209556
Name:SPAGNOLO, MICHAEL ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:SPAGNOLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11535 NUCKOLS RD
Mailing Address - Street 2:STE. D
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5671
Mailing Address - Country:US
Mailing Address - Phone:804-747-5464
Mailing Address - Fax:804-747-5483
Practice Address - Street 1:11535 NUCKOLS RD
Practice Address - Street 2:STE. D
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5671
Practice Address - Country:US
Practice Address - Phone:804-747-5464
Practice Address - Fax:804-747-5483
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001916111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAOOW088G01Medicare ID - Type Unspecified