Provider Demographics
NPI:1699846162
Name:GIASULLO, LOUIS JAMES (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:JAMES
Last Name:GIASULLO
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7130
Mailing Address - Country:US
Mailing Address - Phone:973-575-8363
Mailing Address - Fax:973-575-4027
Practice Address - Street 1:1140 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 216
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7130
Practice Address - Country:US
Practice Address - Phone:973-575-8363
Practice Address - Fax:973-575-4027
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00148500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU79628Medicare UPIN