Provider Demographics
NPI:1114040144
Name:AMITY CHIROPRACTIC & REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:AMITY CHIROPRACTIC & REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:COCCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-397-2211
Mailing Address - Street 1:194 AMITY RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2239
Mailing Address - Country:US
Mailing Address - Phone:203-397-2211
Mailing Address - Fax:203-389-4055
Practice Address - Street 1:194 AMITY RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2239
Practice Address - Country:US
Practice Address - Phone:203-397-2211
Practice Address - Fax:203-389-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03228Medicare ID - Type Unspecified