Provider Demographics
NPI:1437386323
Name:CHIROPRACTIC & WELLNESS CENTER OF NEW HAVEN
Entity Type:Organization
Organization Name:CHIROPRACTIC & WELLNESS CENTER OF NEW HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HRYB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-605-9721
Mailing Address - Street 1:59 ELM ST
Mailing Address - Street 2:100
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2047
Mailing Address - Country:US
Mailing Address - Phone:203-909-6173
Mailing Address - Fax:
Practice Address - Street 1:59 ELM ST
Practice Address - Street 2:100
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2047
Practice Address - Country:US
Practice Address - Phone:203-909-6173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty