Provider Demographics
NPI:1386823623
Name:SUDOWSKI CHIROPRACTIC OFFICES
Entity Type:Organization
Organization Name:SUDOWSKI CHIROPRACTIC OFFICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:G
Authorized Official - Last Name:SUDOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-442-3180
Mailing Address - Street 1:210 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2819
Mailing Address - Country:US
Mailing Address - Phone:860-442-3180
Mailing Address - Fax:860-447-9444
Practice Address - Street 1:210 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2819
Practice Address - Country:US
Practice Address - Phone:860-442-3180
Practice Address - Fax:860-447-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT00317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCO1978Medicare PIN