Provider Demographics
NPI:1891702528
Name:MASSARO, DEAN K (DC)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:K
Last Name:MASSARO
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 1:1515 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6641
Mailing Address - Country:US
Mailing Address - Phone:330-369-2225
Mailing Address - Fax:330-394-2224
Practice Address - Street 1:1515 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6641
Practice Address - Country:US
Practice Address - Phone:330-369-2225
Practice Address - Fax:330-394-2224
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1431111N00000X
CA20303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0906881Medicaid
OH0906881Medicaid
OHMA-0730181Medicare ID - Type Unspecified