Healthcare Provider Details

I. General information

NPI: 1679535090
Provider Name (Legal Business Name): MICHAEL S. FRIGIOLA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SHAFER DR UNIT 101
BRODHEADSVILLE PA
18322-7154
US

IV. Provider business mailing address

110 SHAFER DR UNIT 101
BRODHEADSVILLE PA
18322-7154
US

V. Phone/Fax

Practice location:
  • Phone: 570-992-7800
  • Fax: 570-992-0494
Mailing address:
  • Phone: 570-992-7800
  • Fax: 570-992-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC1701
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: