Provider Demographics
NPI:1437575115
Name:MLM CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MLM CHIROPRACTIC LLC
Other - Org Name:MONTVILLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-848-8977
Mailing Address - Street 1:9 MAPLE AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-2417
Mailing Address - Country:US
Mailing Address - Phone:860-848-8977
Mailing Address - Fax:860-848-3572
Practice Address - Street 1:9 MAPLE AVENUE EXT
Practice Address - Street 2:
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382-2417
Practice Address - Country:US
Practice Address - Phone:860-848-8977
Practice Address - Fax:860-848-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001446302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization