Provider Demographics
NPI:1548354772
Name:CHIUSANO, MIGUEL (DC)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:CHIUSANO
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:PO BOX 1696
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-0010
Mailing Address - Country:US
Mailing Address - Phone:817-419-7091
Mailing Address - Fax:817-465-3580
Practice Address - Street 1:130 E BARDIN RD
Practice Address - Street 2:SUITE 144
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-5260
Practice Address - Country:US
Practice Address - Phone:817-419-7091
Practice Address - Fax:817-465-3580
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6974111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU64220Medicare UPIN
TX605601Medicare ID - Type Unspecified