1215302815 NPI number — CHIROPRACTIC & HEALTH ASSOCIATES, LLC

Table of content: (NPI 1215302815)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215302815 NPI number — CHIROPRACTIC & HEALTH ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC & HEALTH ASSOCIATES, 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:
1215302815
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
404 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06795-2231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-631-0555
Provider Business Mailing Address Fax Number:
203-486-8237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
404 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06795-2231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-631-0555
Provider Business Practice Location Address Fax Number:
203-486-8237
Provider Enumeration Date:
12/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
SOLE OWNER / CHIROPRACTOR
Authorized Official Telephone Number:
860-631-0555

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1631 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1669400354 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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