Provider Demographics
NPI:1477735454
Name:DR. JOHN L. MORMILE CHIROPRACTOR LLC
Entity Type:Organization
Organization Name:DR. JOHN L. MORMILE CHIROPRACTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORMILE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-342-7277
Mailing Address - Street 1:234 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1861
Mailing Address - Country:US
Mailing Address - Phone:860-342-7277
Mailing Address - Fax:860-342-7281
Practice Address - Street 1:234 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1861
Practice Address - Country:US
Practice Address - Phone:860-342-7277
Practice Address - Fax:860-342-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03833Medicare PIN