Provider Demographics
NPI:1083603559
Name:MEDER, DAVID D (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
Last Name:MEDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:MEDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:12 CASE ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2222
Mailing Address - Country:US
Mailing Address - Phone:860-887-4325
Mailing Address - Fax:860-823-1426
Practice Address - Street 1:12 CASE ST
Practice Address - Street 2:SUITE 312
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2222
Practice Address - Country:US
Practice Address - Phone:860-887-4325
Practice Address - Fax:860-823-1426
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U7415Medicare UPIN
CT350001287Medicare ID - Type Unspecified