Provider Demographics
NPI:1992896211
Name:PANGONIS, MICHAEL CHARLES (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHARLES
Last Name:PANGONIS
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 1:300 FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-2183
Mailing Address - Country:US
Mailing Address - Phone:724-758-5733
Mailing Address - Fax:724-758-7617
Practice Address - Street 1:300 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-2183
Practice Address - Country:US
Practice Address - Phone:724-758-5733
Practice Address - Fax:724-758-7617
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007733L111N00000X
PAAJ007733L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA826363OtherBLUE CROSS/BLUE SHIELD
PA114030OtherMEDICARE
PA043106Medicare ID - Type Unspecified
PA114030OtherMEDICARE