Provider Demographics
NPI:1275681850
Name:AXMAN, DAVID GLENN (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GLENN
Last Name:AXMAN
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 1:3074 WHITNEY AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2391
Mailing Address - Country:US
Mailing Address - Phone:203-230-1212
Mailing Address - Fax:203-230-2525
Practice Address - Street 1:3074 WHITNEY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2391
Practice Address - Country:US
Practice Address - Phone:203-230-1212
Practice Address - Fax:203-230-2525
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT786111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
U02577Medicare UPIN
350000567Medicare ID - Type Unspecified