Provider Demographics
NPI:1417220120
Name:MICHAUD CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:MICHAUD CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-533-0094
Mailing Address - Street 1:112 SPENCER ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4601
Mailing Address - Country:US
Mailing Address - Phone:860-533-0094
Mailing Address - Fax:860-533-0122
Practice Address - Street 1:112 SPENCER ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4601
Practice Address - Country:US
Practice Address - Phone:860-533-0094
Practice Address - Fax:860-533-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001781111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12336191OtherCAQH