Provider Demographics
NPI:1104877653
Name:SAPORITO, RICHARD PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PAUL
Last Name:SAPORITO
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 262
Mailing Address - Street 2:655 TERRYVILLE AVENUE
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-0262
Mailing Address - Country:US
Mailing Address - Phone:860-589-1491
Mailing Address - Fax:860-583-3581
Practice Address - Street 1:665 TERRYVILLE AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010
Practice Address - Country:US
Practice Address - Phone:860-589-1491
Practice Address - Fax:860-583-3581
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000445111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050445Medicare UPIN
CT44-04593Medicare UPIN
CT050000445CT01Medicare UPIN
CT948473Medicare UPIN
CTP792545Medicare UPIN
T23412Medicare UPIN
CT350000303Medicare ID - Type UnspecifiedMEDICARE / FIRST COAST SE