Healthcare Provider Details

I. General information

NPI: 1114008521
Provider Name (Legal Business Name): EDWARD A DESSAU D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WHITE ST
SHELTON CT
06484-3129
US

IV. Provider business mailing address

45 WHITE ST
SHELTON CT
06484-3129
US

V. Phone/Fax

Practice location:
  • Phone: 203-924-7557
  • Fax: 203-924-1112
Mailing address:
  • Phone: 203-924-7557
  • Fax: 203-924-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number000751
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number000751
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number000751
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: