Provider Demographics
NPI:1053461061
Name:IMPAGLIA, MICHAEL ANGELO III (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANGELO
Last Name:IMPAGLIA
Suffix:III
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 1:2827 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059-9635
Mailing Address - Country:US
Mailing Address - Phone:716-608-7075
Mailing Address - Fax:
Practice Address - Street 1:4721 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4898
Practice Address - Country:US
Practice Address - Phone:716-608-7075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC7062Medicare ID - Type Unspecified