Provider Demographics
NPI:1265024905
Name:NORTHERN LIGHTS FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:NORTHERN LIGHTS FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIRORPACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-949-2868
Mailing Address - Street 1:65 S MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-1548
Mailing Address - Country:US
Mailing Address - Phone:802-882-8777
Mailing Address - Fax:
Practice Address - Street 1:65 S MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-1548
Practice Address - Country:US
Practice Address - Phone:802-882-8777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty