Provider Demographics
NPI:1265474415
Name:PLATT, MARC W (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:W
Last Name:PLATT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1306
Mailing Address - Country:US
Mailing Address - Phone:203-239-2323
Mailing Address - Fax:203-239-3325
Practice Address - Street 1:336 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1306
Practice Address - Country:US
Practice Address - Phone:203-239-2323
Practice Address - Fax:203-239-3325
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT23372Medicare UPIN