Provider Demographics
NPI:1497700249
Name:BIZZARO, PAUL M (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:BIZZARO
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 1:81 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-1510
Mailing Address - Country:US
Mailing Address - Phone:215-493-6589
Mailing Address - Fax:215-493-1022
Practice Address - Street 1:81 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-1510
Practice Address - Country:US
Practice Address - Phone:215-493-6589
Practice Address - Fax:215-493-1022
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00396400111N00000X
PADC-004333-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5379300Medicaid
NJ617054Medicare UPIN
NJ5379300Medicaid