Provider Demographics
NPI:1962610154
Name:DEPAOLIS, DAVID A (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:DEPAOLIS
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 1:82 N FINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1145
Mailing Address - Country:US
Mailing Address - Phone:908-630-0909
Mailing Address - Fax:
Practice Address - Street 1:266-268 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2592
Practice Address - Country:US
Practice Address - Phone:862-237-7847
Practice Address - Fax:862-237-7850
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00458900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor