Provider Demographics
NPI:1366774820
Name:VILELLO, MICHAEL A (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:VILELLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9555 LEBANON RD
Mailing Address - Street 2:STE. 104
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6095
Mailing Address - Country:US
Mailing Address - Phone:469-362-5711
Mailing Address - Fax:844-846-4610
Practice Address - Street 1:9555 LEBANON RD
Practice Address - Street 2:STE. 104
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-6095
Practice Address - Country:US
Practice Address - Phone:469-362-5711
Practice Address - Fax:844-846-4610
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor