Provider Demographics
NPI:1447426630
Name:THORACIC PARK ALTERNATIVE HEALTH
Entity Type:Organization
Organization Name:THORACIC PARK ALTERNATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATAVINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-758-7250
Mailing Address - Street 1:60 WATERBURY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1250
Mailing Address - Country:US
Mailing Address - Phone:203-758-7250
Mailing Address - Fax:
Practice Address - Street 1:60 WATERBURY RD
Practice Address - Street 2:SUITE C
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1250
Practice Address - Country:US
Practice Address - Phone:203-758-7250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03214Medicare PIN
CTU97207Medicare UPIN