Healthcare Provider Details

I. General information

NPI: 1518049246
Provider Name (Legal Business Name): MICHAEL SALVATORE MAGGIO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LOMAS BLVD NW SUITE #1
ALBUQUERQUE NM
87102-1863
US

IV. Provider business mailing address

1100 LOMAS BLVD NW SUITE #1
ALBUQUERQUE NM
87102-1863
US

V. Phone/Fax

Practice location:
  • Phone: 505-242-8400
  • Fax: 505-242-4340
Mailing address:
  • Phone: 505-242-8400
  • Fax: 505-242-4340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1323
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: