Healthcare Provider Details

I. General information

NPI: 1942492780
Provider Name (Legal Business Name): MICHAEL ANTHONY CAPOBIANCO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 STATE ROUTE 800 NE STE D
MAGNOLIA OH
44643-8322
US

IV. Provider business mailing address

11201 STATE ROUTE 800 NE STE D
MAGNOLIA OH
44643-8322
US

V. Phone/Fax

Practice location:
  • Phone: 330-694-1695
  • Fax:
Mailing address:
  • Phone: 330-694-1695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2811
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: