Provider Demographics
NPI:1942492780
Name:CAPOBIANCO, MICHAEL ANTHONY (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:CAPOBIANCO
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 1:11201 STATE ROUTE 800 NE STE D
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:OH
Mailing Address - Zip Code:44643-8322
Mailing Address - Country:US
Mailing Address - Phone:330-694-1695
Mailing Address - Fax:
Practice Address - Street 1:11201 STATE ROUTE 800 NE STE D
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:OH
Practice Address - Zip Code:44643-8322
Practice Address - Country:US
Practice Address - Phone:330-694-1695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
4309811Medicare PIN