Provider Demographics
NPI:1396868451
Name:SPAGNOLI, MICHAEL ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:SPAGNOLI
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:PO BOX 8549
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91372-8549
Mailing Address - Country:US
Mailing Address - Phone:818-225-5900
Mailing Address - Fax:818-225-5905
Practice Address - Street 1:4766 PARK GRANADA STE 114
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-3348
Practice Address - Country:US
Practice Address - Phone:818-225-5900
Practice Address - Fax:818-225-5905
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17829111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC17829Medicare UPIN