Provider Demographics
NPI:1184815219
Name:DOCTOR R MARK PAPPAS, PC
Entity Type:Organization
Organization Name:DOCTOR R MARK PAPPAS, PC
Other - Org Name:PAPPAS CHIROPRACTIC CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:PAPPAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-937-7246
Mailing Address - Street 1:299 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-7307
Mailing Address - Country:US
Mailing Address - Phone:203-937-7246
Mailing Address - Fax:203-931-9266
Practice Address - Street 1:299 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-7307
Practice Address - Country:US
Practice Address - Phone:203-937-7246
Practice Address - Fax:203-931-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000575CT01OtherANTHEM BLUE CROSS
CTC03776Medicare PIN
CT050000575CT01OtherANTHEM BLUE CROSS