Provider Demographics
NPI:1124197454
Name:PAGANO, MATTHEW NEIL (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:NEIL
Last Name:PAGANO
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-1227
Mailing Address - Country:US
Mailing Address - Phone:860-379-3372
Mailing Address - Fax:860-379-3373
Practice Address - Street 1:179 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WINSTED
Practice Address - State:CT
Practice Address - Zip Code:06098-1227
Practice Address - Country:US
Practice Address - Phone:860-379-3372
Practice Address - Fax:860-379-3373
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001114CT01OtherANTHEM BLUE CROSS
CT111410OtherCONNECTICARE
CT219OtherA.C.N.
CT5449414OtherAETNA
CTOXFORDOtherOXFORD