Provider Demographics
NPI:1033655295
Name:VREELAND, MARIGOT (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIGOT
Middle Name:
Last Name:VREELAND
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 1:955 MAIN ST
Mailing Address - Street 2:APT 701
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-4300
Mailing Address - Country:US
Mailing Address - Phone:203-772-9533
Mailing Address - Fax:
Practice Address - Street 1:955 MAIN ST
Practice Address - Street 2:APT 701
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4300
Practice Address - Country:US
Practice Address - Phone:203-772-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001985111N00000X
NY012818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor