Provider Demographics
NPI:1346366945
Name:MURSCH, PETRA IRMGARD (DC)
Entity Type:Individual
Prefix:MS
First Name:PETRA
Middle Name:IRMGARD
Last Name:MURSCH
Suffix:
Gender:F
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 695
Mailing Address - Street 2:
Mailing Address - City:EAST GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06026
Mailing Address - Country:US
Mailing Address - Phone:860-653-5662
Mailing Address - Fax:860-653-8217
Practice Address - Street 1:56A RAINBOW ROAD
Practice Address - Street 2:
Practice Address - City:EAST GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06026
Practice Address - Country:US
Practice Address - Phone:860-653-5662
Practice Address - Fax:860-653-8217
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD60304OtherCONNECTICARE
CT050000434CT01OtherBCBS
T22549Medicare UPIN