Provider Demographics
NPI:1316019797
Name:WRINN, STEPHEN M (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:WRINN
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:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-0209
Mailing Address - Country:US
Mailing Address - Phone:860-349-2070
Mailing Address - Fax:860-349-2080
Practice Address - Street 1:360 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:DURHAM
Practice Address - State:CT
Practice Address - Zip Code:06422-1644
Practice Address - Country:US
Practice Address - Phone:860-349-2070
Practice Address - Fax:860-349-2080
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350000513Medicare ID - Type Unspecified