Provider Demographics
NPI:1346289972
Name:VERTICCHIO, PAUL JOHN (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOHN
Last Name:VERTICCHIO
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 1:706 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-1290
Mailing Address - Country:US
Mailing Address - Phone:864-948-0035
Mailing Address - Fax:864-948-0084
Practice Address - Street 1:706 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1290
Practice Address - Country:US
Practice Address - Phone:864-948-0035
Practice Address - Fax:864-948-0084
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1346289972OtherNPI