Provider Demographics
NPI:1235558461
Name:CARBONE CHIROPRACTIC CENTER DBA SOUTHSIDE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:CARBONE CHIROPRACTIC CENTER DBA SOUTHSIDE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-748-9090
Mailing Address - Street 1:82-86 WOLCOTT HILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1252
Mailing Address - Country:US
Mailing Address - Phone:860-436-3151
Mailing Address - Fax:860-436-3277
Practice Address - Street 1:82-86 WOLCOTT HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1252
Practice Address - Country:US
Practice Address - Phone:860-436-3151
Practice Address - Fax:860-436-3277
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARBONE CHIROPRACTIC CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-15
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty