Provider Demographics
NPI:1083054969
Name:SIEGEL CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:SIEGEL CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENNETT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-674-1992
Mailing Address - Street 1:28 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3801
Mailing Address - Country:US
Mailing Address - Phone:860-674-1992
Mailing Address - Fax:860-674-9664
Practice Address - Street 1:28 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3801
Practice Address - Country:US
Practice Address - Phone:860-674-1992
Practice Address - Fax:860-674-9664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty