Provider Demographics
NPI:1568514628
Name:DESANTIS, DAVID PAUL (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:DESANTIS
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 1:7747 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5726
Mailing Address - Country:US
Mailing Address - Phone:330-729-9111
Mailing Address - Fax:330-729-9015
Practice Address - Street 1:7747 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5726
Practice Address - Country:US
Practice Address - Phone:330-729-9111
Practice Address - Fax:330-729-9015
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1974111NR0400X
OH2974111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation