Provider Demographics
NPI:1083968283
Name:NEW HAVEN FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:NEW HAVEN FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KUTZ-COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-237-7800
Mailing Address - Street 1:105 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MO
Mailing Address - Zip Code:63068-1426
Mailing Address - Country:US
Mailing Address - Phone:573-237-7800
Mailing Address - Fax:573-234-6542
Practice Address - Street 1:105 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MO
Practice Address - Zip Code:63068-1426
Practice Address - Country:US
Practice Address - Phone:573-237-7800
Practice Address - Fax:573-234-6542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
384104OtherHEALTHLINK
4401300OtherUNITED HEALTH CARE
118500OtherBLUE CROSS BLUE SHIELD
118500OtherBLUE CROSS BLUE SHIELD