Provider Demographics
NPI:1013001353
Name:SEO, CONNIE (DC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:SEO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 POST RD
Mailing Address - Street 2:SUITE L2
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1258
Mailing Address - Country:US
Mailing Address - Phone:203-254-9432
Mailing Address - Fax:203-254-9462
Practice Address - Street 1:2600 POST RD
Practice Address - Street 2:SUITE L2
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1258
Practice Address - Country:US
Practice Address - Phone:203-254-9432
Practice Address - Fax:203-254-9462
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor