Provider Demographics
NPI:1104017870
Name:EMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:EMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:HOBSON
Authorized Official - Last Name:KALK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-745-8000
Mailing Address - Street 1:258 HAZARD AVE
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4613
Mailing Address - Country:US
Mailing Address - Phone:860-745-8000
Mailing Address - Fax:860-745-8212
Practice Address - Street 1:258 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4613
Practice Address - Country:US
Practice Address - Phone:860-745-8000
Practice Address - Fax:860-745-8212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02864Medicare PIN