1033312517 NPI number — HUNTINGTON CHIROPRACTIC CENTER, LLC

Table of content: (NPI 1033312517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033312517 NPI number — HUNTINGTON CHIROPRACTIC CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNTINGTON CHIROPRACTIC CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033312517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 HUNTINGTON PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06484-5211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-926-9841
Provider Business Mailing Address Fax Number:
203-926-1681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 HUNTINGTON PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06484-5211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-926-9841
Provider Business Practice Location Address Fax Number:
203-926-1681
Provider Enumeration Date:
06/11/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LITTS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
HOWARD
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
203-926-9841

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  001258 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 001218 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C02311 . This is a "GROUP IDENTIFIER" identifier . This identifiers is of the category "OTHER".