Provider Demographics
NPI:1437331824
Name:SAND PIT CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:SAND PIT CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:KISKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-791-9111
Mailing Address - Street 1:67 SAND PIT RD
Mailing Address - Street 2:SUITE 99
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4032
Mailing Address - Country:US
Mailing Address - Phone:203-791-9111
Mailing Address - Fax:203-791-9743
Practice Address - Street 1:67 SAND PIT RD
Practice Address - Street 2:SUITE 99
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4032
Practice Address - Country:US
Practice Address - Phone:203-791-9111
Practice Address - Fax:203-791-9743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001577111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU99891Medicare UPIN
CTC03318Medicare PIN