Provider Demographics
NPI:1609959097
Name:DESCHAMP, PAUL W (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:DESCHAMP
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 1:508 WEST PEARCE
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-1328
Mailing Address - Country:US
Mailing Address - Phone:636-327-8844
Mailing Address - Fax:636-327-8844
Practice Address - Street 1:508 WEST PEARCE
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1328
Practice Address - Country:US
Practice Address - Phone:636-327-8844
Practice Address - Fax:636-327-8844
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5594OtherBLUE CROSS
MO34487OtherPNCS
MO34487OtherPNCS