Provider Demographics
NPI:1093781262
Name:HEALY, ATHENA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:MARIE
Last Name:HEALY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 FEDERAL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811-4047
Mailing Address - Country:US
Mailing Address - Phone:120-377-8222
Mailing Address - Fax:120-377-8059
Practice Address - Street 1:132 FEDERAL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811-4047
Practice Address - Country:US
Practice Address - Phone:120-377-8222
Practice Address - Fax:120-377-8059
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT10442675OtherCAQH
CT350001075Medicare PIN
CT10442675OtherCAQH