Provider Demographics
NPI:1346446267
Name:MODERN CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:MODERN CHIROPRACTIC, LLC
Other - Org Name:BURLINGTON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:SALAVATORE
Authorized Official - Last Name:PIANA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-673-5152
Mailing Address - Street 1:267 SPIELMAN HWY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06013-1734
Mailing Address - Country:US
Mailing Address - Phone:860-673-5152
Mailing Address - Fax:860-760-6066
Practice Address - Street 1:267 SPIELMAN HWY
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CT
Practice Address - Zip Code:06013-1734
Practice Address - Country:US
Practice Address - Phone:860-673-5152
Practice Address - Fax:860-760-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000965111N00000X
CT000904111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU28778Medicare UPIN