Provider Demographics
NPI:1083769830
Name:MASCETTA, CHRISTOPHER CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:CHARLES
Last Name:MASCETTA
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 1:3 LAMAR RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-3943
Mailing Address - Country:US
Mailing Address - Phone:203-798-0525
Mailing Address - Fax:
Practice Address - Street 1:10 SOUTH ST
Practice Address - Street 2:STE 205
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4124
Practice Address - Country:US
Practice Address - Phone:203-431-1688
Practice Address - Fax:203-431-1817
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350001062Medicare ID - Type Unspecified