Provider Demographics
NPI:1013022185
Name:MIGLIACCIO, DALE MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:MICHAEL
Last Name:MIGLIACCIO
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 1:3892 STATE ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3185
Mailing Address - Country:US
Mailing Address - Phone:805-687-0566
Mailing Address - Fax:
Practice Address - Street 1:3892 STATE ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3185
Practice Address - Country:US
Practice Address - Phone:805-687-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16005111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC16005Medicare ID - Type UnspecifiedLICENSE #