Individual provider Active NPI

David Spadaro, D.C

  • Chiropractor
  • Derby, CT
National Provider Identifier
1225329915
Registry record updated Jun 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
001872 Issued in CT
Practice address
111 New Haven Ave Ste 6
Derby, CT 06418-2197
Phone
(203) 736-6356
Fax
(203) 308-2048
NPI assigned
Apr 28, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 001872 CT Primary

Addresses

Primary practice location

111 New Haven Ave Ste 6
Derby, CT 06418-2197

Mailing address

111 New Haven Ave Ste 6
Derby, CT 06418-2197
Phone (203) 736-6356

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201219000108 CT Practitioner - Chiropractic 5597177352 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
001872CTMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Charter Oak Health Center, Inc. CurrentSince Dec 9, 2020 Accepting new patients
Charter Oak Health Center, Inc. CurrentSince Dec 9, 2020 Accepting new patients
Omni Physical & Aquatic Therapy Center, Inc Chiropractor Past Accepting new patients

Locations

21 Grand St
Hartford, CT 06106

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402617600000",
    "number": "1225329915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 NEW HAVEN AVE STE 6",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064182197",
            "telephone_number": "203-736-6356",
            "fax_number": "203-308-2048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 NEW HAVEN AVE STE 6",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064182197",
            "telephone_number": "203-736-6356",
            "fax_number": "203-308-2048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPADARO",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-04-28",
        "last_updated": "2014-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CT",
            "license": "001872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Derby, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.