Provider Demographics
NPI:1053415521
Name:PIAZZA, MICHAEL KENT (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KENT
Last Name:PIAZZA
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 1:9677 N BOYD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4275
Mailing Address - Country:US
Mailing Address - Phone:559-681-1738
Mailing Address - Fax:559-681-1738
Practice Address - Street 1:9677 N BOYD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-4275
Practice Address - Country:US
Practice Address - Phone:559-681-1738
Practice Address - Fax:559-681-1738
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC-0235670Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
CAU65288Medicare UPIN