Provider Demographics
NPI:1922060862
Name:BASILE, PAUL F (DC, CCRD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:BASILE
Suffix:
Gender:M
Credentials:DC, CCRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 W HAMILTON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6447
Mailing Address - Country:US
Mailing Address - Phone:610-435-8880
Mailing Address - Fax:610-435-3494
Practice Address - Street 1:2015 W HAMILTON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6447
Practice Address - Country:US
Practice Address - Phone:610-435-8880
Practice Address - Fax:610-435-3494
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002152L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0796180Medicaid
PA0796180Medicaid
PAT27190Medicare UPIN