Provider Demographics
NPI:1528470390
Name:CAVALLARO, VINCENT (DC)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:CAVALLARO
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 1:264 FREEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4021
Mailing Address - Country:US
Mailing Address - Phone:845-699-2342
Mailing Address - Fax:
Practice Address - Street 1:264 FREEMAN AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4021
Practice Address - Country:US
Practice Address - Phone:845-699-2342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00717300111N00000X
NYX012521111N00000X
CT002158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor