Provider Demographics
NPI:1326265927
Name:NUZZOLO, WALTER J (DC)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:J
Last Name:NUZZOLO
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 378
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05763-0378
Mailing Address - Country:US
Mailing Address - Phone:802-483-9336
Mailing Address - Fax:
Practice Address - Street 1:2981 RT 7
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:VT
Practice Address - Zip Code:05763-0378
Practice Address - Country:US
Practice Address - Phone:802-483-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006-0000760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor