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General NPI Number Information
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NPI Number | 1699859637
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Entity Type | Individual
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Provider Name | MICHAEL J MORIBALDI DC
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 4343 SHALLOWFORD RD SUITE B6
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City | MARIETTA
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State | GA
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Zip | 30062-5023
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Country | US
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Telephone | 770-649-1730
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Fax | 770-649-1731
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Provider Business Mailing Address
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Address Line | 4343 SHALLOWFORD RD SUITE B6
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City | MARIETTA
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State | GA
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Zip | 30062-5023
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Country | US
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Telephone | 770-649-1730
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Fax | 770-649-1731
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 005452
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License Number State | GA
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