Provider Demographics
NPI:1497253991
Name:VELOCITY SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:VELOCITY SPORTS MEDICINE LLC
Other - Org Name:VELOCITY SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC ICCSP, MS
Authorized Official - Phone:203-913-0169
Mailing Address - Street 1:221 POST RD W
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4653
Mailing Address - Country:US
Mailing Address - Phone:203-557-6569
Mailing Address - Fax:203-557-6566
Practice Address - Street 1:221 POST RD W
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4653
Practice Address - Country:US
Practice Address - Phone:203-557-6569
Practice Address - Fax:203-557-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1918111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty