Healthcare Provider Details

I. General information

NPI: 1225329915
Provider Name (Legal Business Name): DAVID SPADARO D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NEW HAVEN AVE STE 6
DERBY CT
06418-2197
US

IV. Provider business mailing address

111 NEW HAVEN AVE STE 6
DERBY CT
06418-2197
US

V. Phone/Fax

Practice location:
  • Phone: 203-736-6356
  • Fax: 203-308-2048
Mailing address:
  • Phone: 203-736-6356
  • Fax: 203-308-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001872
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: