Provider Demographics
NPI:1154634665
Name:MERIDEN CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:MERIDEN CHIROPRACTIC, LLC
Other - Org Name:MERIDEN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ODONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-440-9686
Mailing Address - Street 1:693 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4341
Mailing Address - Country:US
Mailing Address - Phone:203-440-9686
Mailing Address - Fax:203-440-9689
Practice Address - Street 1:693 BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-4341
Practice Address - Country:US
Practice Address - Phone:203-440-9686
Practice Address - Fax:203-440-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty