Provider Demographics
NPI:1457357030
Name:MUSCO, PAUL FREDERICK SR (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:FREDERICK
Last Name:MUSCO
Suffix:SR
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 1:738 SAVIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-4314
Mailing Address - Country:US
Mailing Address - Phone:203-933-1918
Mailing Address - Fax:203-933-1955
Practice Address - Street 1:738 SAVIN AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4314
Practice Address - Country:US
Practice Address - Phone:203-933-1918
Practice Address - Fax:203-933-1955
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-09
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
CT000237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT23196Medicare UPIN