1497921449 NPI number — BACK TO HEALTH CHIROPRACTIC OF STRATFORD PC

Table of content: (NPI 1497921449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497921449 NPI number — BACK TO HEALTH CHIROPRACTIC OF STRATFORD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK TO HEALTH CHIROPRACTIC OF STRATFORD PC
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:
1497921449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3355 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STRATFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06614-4845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-381-9703
Provider Business Mailing Address Fax Number:
203-381-9802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3355 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STRATFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06614-4845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-381-9703
Provider Business Practice Location Address Fax Number:
203-381-9802
Provider Enumeration Date:
04/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
YOO
Authorized Official First Name:
KEUMHONG
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
203-381-9703

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  17007 , 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: 050000899CT03 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 42701395 . This is a "BENEFIT CONCEPTS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 000001470878 . This is a "PRIVATE HEALTHCARE SYSTEMS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 050001707CT01 . This is a "BC BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 745717 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 9812065 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 183592 . This is a "WELLCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: NHS467 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P4003952 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 42701395 . This is a "GOLDEN RULE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 050000899CT04 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 12724992 . This is a "MULTIPLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 42701395 . This is a "A C N" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 4298598 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 42701395 . This is a "GREAT WEST" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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