Provider Demographics
NPI:1841377421
Name:CORRADO, DAVID PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:CORRADO
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 1:151 GREENTREE RD STE C
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9416
Mailing Address - Country:US
Mailing Address - Phone:856-596-0086
Mailing Address - Fax:856-596-0085
Practice Address - Street 1:151 GREENTREE RD STE C
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-9416
Practice Address - Country:US
Practice Address - Phone:856-596-0086
Practice Address - Fax:856-596-0085
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005767L111N00000X
NJ38MC00460300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6670709Medicaid
NJ6670709Medicaid
802793MEOMedicare ID - Type Unspecified