Provider Demographics
NPI:1205901303
Name:SBARRA, PAUL LOUIS (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LOUIS
Last Name:SBARRA
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 1:2224 S CLARION ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2918
Mailing Address - Country:US
Mailing Address - Phone:267-237-0022
Mailing Address - Fax:
Practice Address - Street 1:1214 MOORE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1516
Practice Address - Country:US
Practice Address - Phone:215-271-0318
Practice Address - Fax:215-271-0319
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007573L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACA081517Medicare ID - Type UnspecifiedGROUP NUMBER
PA034757SZDMedicare PIN