Provider Demographics
NPI:1235296286
Name:ANASTASIO, PAUL A (DC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:ANASTASIO
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 1:11 PLEASANT LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:HARWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02645-2661
Mailing Address - Country:US
Mailing Address - Phone:508-432-7855
Mailing Address - Fax:508-432-5088
Practice Address - Street 1:11 PLEASANT LAKE AVE
Practice Address - Street 2:
Practice Address - City:HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02645-2661
Practice Address - Country:US
Practice Address - Phone:508-432-7855
Practice Address - Fax:508-432-5088
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001836OtherTUFTS HEALTH CARE
MA351419OtherHARVARD PILGRIM
MAY36397OtherBLUE CROSS BLUE SHIELD
MA1610406Medicaid
MA00007803212OtherAETNA
MA00007803212OtherAETNA
MA1610406Medicaid