Provider Demographics
NPI:1861597841
Name:DATTILO, MICHAEL R (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:DATTILO
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 1:810 OHIO PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-2219
Mailing Address - Country:US
Mailing Address - Phone:513-947-8970
Mailing Address - Fax:513-947-8972
Practice Address - Street 1:810 OHIO PIKE STE B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-2219
Practice Address - Country:US
Practice Address - Phone:513-947-8970
Practice Address - Fax:513-947-8972
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3155111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2478135Medicaid
OHU86027Medicare UPIN
OH2478135Medicaid