Provider Demographics
NPI:1700911872
Name:DAIUTO, MICHAEL SR (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:DAIUTO
Suffix:SR
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 1:9515 DEERECO RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2116
Mailing Address - Country:US
Mailing Address - Phone:410-252-0040
Mailing Address - Fax:410-252-0161
Practice Address - Street 1:9515 DEERECO RD
Practice Address - Street 2:SUITE 305
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2116
Practice Address - Country:US
Practice Address - Phone:410-252-0040
Practice Address - Fax:410-252-0161
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01893111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU83042Medicare UPIN