Healthcare Provider Details

I. General information

NPI: 1821298662
Provider Name (Legal Business Name): DEAN J MICALIZIO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 W ROYAL PALM RD
PHOENIX AZ
85021-5657
US

IV. Provider business mailing address

918 W ROYAL PALM RD
PHOENIX AZ
85021-5657
US

V. Phone/Fax

Practice location:
  • Phone: 602-358-8883
  • Fax:
Mailing address:
  • Phone: 602-358-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4280
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: