Healthcare Provider Details

I. General information

NPI: 1518065648
Provider Name (Legal Business Name): PAUL RICHARD DILAURO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 BIG TREE RD
BLASDELL NY
14219-2905
US

IV. Provider business mailing address

4251 BIG TREE RD
BLASDELL NY
14219-2905
US

V. Phone/Fax

Practice location:
  • Phone: 716-648-0357
  • Fax:
Mailing address:
  • Phone: 716-648-0357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX009390-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: