Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 000751 | CT |
N | 111NR0400X | Rehabilitation Chiropractor | 000751 | CT |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 000751 | CT |
NPI | 1114008521 |
---|---|
Provider Name | Dr. Edward A Dessau |
First Address | Shelton, CT 06484-3129 |
Second Address | Shelton, CT 06484-3129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4090487 | (05) | CT |
T78348 | (02) | CT |