Provider Demographics
NPI:1689617219
Name:WAISBROT, PAUL E (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:WAISBROT
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 1:10494 LOVELAND MADEIRA RD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-9338
Mailing Address - Country:US
Mailing Address - Phone:513-697-1800
Mailing Address - Fax:513-697-1888
Practice Address - Street 1:10494 LOVELAND MADEIRA RD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-9338
Practice Address - Country:US
Practice Address - Phone:513-697-1800
Practice Address - Fax:513-697-1888
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2425111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU66868Medicare UPIN
OHWA0828103Medicare PIN