Provider Demographics
NPI:1093860546
Name:CARPENOS, RICHARD MARTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MARTIN
Last Name:CARPENOS
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 1:391 BOSTON POST RD
Mailing Address - Street 2:STE 1
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3578
Mailing Address - Country:US
Mailing Address - Phone:203-393-3435
Mailing Address - Fax:
Practice Address - Street 1:391 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3578
Practice Address - Country:US
Practice Address - Phone:203-799-3472
Practice Address - Fax:203-799-3476
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000551111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT941550OtherPHS
CT4068763Medicaid
CT350000365Medicare ID - Type Unspecified
CT941550OtherPHS