Provider Demographics
NPI:1174614234
Name:DIPASQUALE, PHILIP M (DC, PA)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:M
Last Name:DIPASQUALE
Suffix:
Gender:M
Credentials:DC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ARNOT ST
Mailing Address - Street 2:STE. 3
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1629
Mailing Address - Country:US
Mailing Address - Phone:973-815-0277
Mailing Address - Fax:973-473-6833
Practice Address - Street 1:2 ARNOT ST
Practice Address - Street 2:STE. 3
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-1629
Practice Address - Country:US
Practice Address - Phone:973-815-0277
Practice Address - Fax:973-473-6833
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ2380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP562826OtherOXFORD
NJP562826OtherOXFORD
NJ085396Medicare ID - Type Unspecified
NJ453775TF5Medicare ID - Type Unspecified