Provider Demographics
NPI:1366529422
Name:MIGLIAZZO, JOHN JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:MIGLIAZZO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28404 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1607
Mailing Address - Country:US
Mailing Address - Phone:586-775-6500
Mailing Address - Fax:586-775-6591
Practice Address - Street 1:28404 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1607
Practice Address - Country:US
Practice Address - Phone:586-775-6500
Practice Address - Fax:586-775-6591
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007036111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OE052550OtherBCBSM
MI3267532Medicaid
MI95OE052550OtherBCBSM
U61364Medicare UPIN