Provider Demographics
NPI:1326168758
Name:NEW HAVEN CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:NEW HAVEN CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:CIANCIOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-787-1331
Mailing Address - Street 1:951 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3929
Mailing Address - Country:US
Mailing Address - Phone:203-787-1331
Mailing Address - Fax:203-787-1595
Practice Address - Street 1:951 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3929
Practice Address - Country:US
Practice Address - Phone:203-787-1331
Practice Address - Fax:203-787-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT000271Medicare UPIN