Provider Demographics
NPI:1952741951
Name:SPADAFINO, MICHAEL VITO (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:VITO
Last Name:SPADAFINO
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 1:1127 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3948
Mailing Address - Country:US
Mailing Address - Phone:630-629-9500
Mailing Address - Fax:
Practice Address - Street 1:1127 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3948
Practice Address - Country:US
Practice Address - Phone:630-629-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012425111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor