Provider Demographics
NPI:1265474571
Name:ADVANCED SPINE & SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:ADVANCED SPINE & SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MARSCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-265-7900
Mailing Address - Street 1:26 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3542
Mailing Address - Country:US
Mailing Address - Phone:203-631-5367
Mailing Address - Fax:
Practice Address - Street 1:821 N MAIN STREET EXT
Practice Address - Street 2:SUITE 110
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2464
Practice Address - Country:US
Practice Address - Phone:203-265-7900
Practice Address - Fax:203-265-7756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001350111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty