MEDICARE: DR. MICHAEL JOHN D'AVANZO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X010261	NY

General Provider Information

NPI Number	:	1609945088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOHN D'AVANZO D.C.

Provider Business Mailing Address
First Line	:	65 BROADWAY STE 1003
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10006-2527
Country	:	US
Telephone Number	:	212-379-6535
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 BROADWAY STE 1003
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10006-2527
Country	:	US
Telephone Number	:	212-379-6535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	04/09/2019

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