Provider Demographics
NPI:1528115433
Name:SOTTILE, DEAN (DC)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:
Last Name:SOTTILE
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 1:411 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1333
Mailing Address - Country:US
Mailing Address - Phone:973-473-8975
Mailing Address - Fax:973-773-5426
Practice Address - Street 1:411 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07014-1333
Practice Address - Country:US
Practice Address - Phone:973-473-8975
Practice Address - Fax:973-773-5426
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00558800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ043806Medicare PIN