MEDICARE: DR. MICHAEL ANTHONY MUFFOLETTO 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	18556	CA

General Provider Information

NPI Number	:	1720271745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ANTHONY MUFFOLETTO D.C.

Provider Business Mailing Address
First Line	:	17922 MAGNOLIA ST
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-5039
Country	:	US
Telephone Number	:	714-964-5100
Fax Number	:	714-964-5126

Provider Business Practice Location Address
First Line	:	17922 MAGNOLIA ST
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-5039
Country	:	US
Telephone Number	:	714-964-5100
Fax Number	:	714-964-5126

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	05/06/2015

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