Provider Demographics
NPI:1598764235
Name:PAUL, DOUGLAS J (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:J
Last Name:PAUL
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 1:1335 DUBLIN RD
Mailing Address - Street 2:SUITE 75-A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1000
Mailing Address - Country:US
Mailing Address - Phone:614-485-9320
Mailing Address - Fax:614-485-9321
Practice Address - Street 1:1335 DUBLIN RD
Practice Address - Street 2:SUITE 75-A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1000
Practice Address - Country:US
Practice Address - Phone:614-485-9320
Practice Address - Fax:614-485-9321
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2335619Medicaid
OHNU9294881OtherMEDICARE GROUP NUMBER
OH2335619Medicaid
OHNU9294881OtherMEDICARE GROUP NUMBER