Provider Demographics
NPI:1700210812
Name:PAULA, JUSTINE FAZIO (DC)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:FAZIO
Last Name:PAULA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2270
Mailing Address - Country:US
Mailing Address - Phone:617-505-6742
Mailing Address - Fax:617-505-6769
Practice Address - Street 1:1620 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2270
Practice Address - Country:US
Practice Address - Phone:617-505-6742
Practice Address - Fax:617-505-6769
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor