Provider Demographics
NPI:1033239397
Name:BUONANNO, VINCENT M (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:M
Last Name:BUONANNO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DEARFIELD DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5351
Mailing Address - Country:US
Mailing Address - Phone:120-366-1669
Mailing Address - Fax:120-366-1187
Practice Address - Street 1:4 DEARFIELD DR
Practice Address - Street 2:SUITE 105
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5351
Practice Address - Country:US
Practice Address - Phone:120-366-1669
Practice Address - Fax:120-366-1187
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT270111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT222346845OtherTAX ID