Provider Demographics
NPI:1093823312
Name:CARDIA, RAFFAELE (DC)
Entity Type:Individual
Prefix:
First Name:RAFFAELE
Middle Name:
Last Name:CARDIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 FARMINGTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-3081
Mailing Address - Country:US
Mailing Address - Phone:860-233-9922
Mailing Address - Fax:860-233-2067
Practice Address - Street 1:609 FARMINGTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-3081
Practice Address - Country:US
Practice Address - Phone:860-233-9922
Practice Address - Fax:860-233-2067
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001144CT02OtherBLUE CROSS BLUE SHIELD