Provider Demographics
NPI:1043469018
Name:NORTH COLONY CHIROPRACTIC
Entity Type:Organization
Organization Name:NORTH COLONY CHIROPRACTIC
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEPIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-949-2225
Mailing Address - Street 1:1245 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1737
Mailing Address - Country:US
Mailing Address - Phone:203-949-2225
Mailing Address - Fax:203-949-0352
Practice Address - Street 1:1245 S BROAD ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1737
Practice Address - Country:US
Practice Address - Phone:203-949-2225
Practice Address - Fax:203-949-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000772111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty