=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619074069
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL C CIATTO D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1620 TOWNE CENTER - RTE.22 BREWSTER CHIROPRACTIC CARE
-----------------------------------------------------
City | BREWSTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-279-1135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 APPLE BLOSSOM LN
-----------------------------------------------------
City | NEW FAIRFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06812-2608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-312-9770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | XO10705
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------