Provider Demographics
NPI:1962482158
Name:DELDEBBIO, PAUL JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:DELDEBBIO
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 1:55 WESLEY ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-4025
Mailing Address - Country:US
Mailing Address - Phone:203-756-6254
Mailing Address - Fax:203-754-7293
Practice Address - Street 1:688 CHASE PKWY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3040
Practice Address - Country:US
Practice Address - Phone:203-756-6254
Practice Address - Fax:203-754-7293
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2008-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT35000355Medicare ID - Type Unspecified