Provider Demographics
NPI:1073504080
Name:PACETTI, PAUL M (DC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:M
Last Name:PACETTI
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 37
Mailing Address - Street 2:575 BAYVIEW RD SUITE 103
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-0037
Mailing Address - Country:US
Mailing Address - Phone:262-363-3909
Mailing Address - Fax:262-363-3801
Practice Address - Street 1:575 BAY VIEW RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1749
Practice Address - Country:US
Practice Address - Phone:262-363-3909
Practice Address - Fax:262-363-3801
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2510012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor