1942226402 NPI number — DR. CHRISTOPHER M COULIS DC

Table of content: DR. CHRISTOPHER M COULIS DC (NPI 1942226402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942226402 NPI number — DR. CHRISTOPHER M COULIS DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COULIS
Provider First Name:
CHRISTOPHER
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

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:
1942226402
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2415 BOSTON POST RD
Provider Second Line Business Mailing Address:
UNIT 11
Provider Business Mailing Address City Name:
GUILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06437-4348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-453-2001
Provider Business Mailing Address Fax Number:
203-453-2010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2415 BOSTON POST RD
Provider Second Line Business Practice Location Address:
UNIT 11
Provider Business Practice Location Address City Name:
GUILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06437-4348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-453-2001
Provider Business Practice Location Address Fax Number:
203-453-2010
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1629 , 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: 50001629 . This is a "BLUE CROSS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 7108792 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: CT23920 . This is a "LANDMARK" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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