Provider Demographics
NPI:1497921449
Name:BACK TO HEALTH CHIROPRACTIC OF STRATFORD PC
Entity Type:Organization
Organization Name:BACK TO HEALTH CHIROPRACTIC OF STRATFORD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEUMHONG
Authorized Official - Middle Name:
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-381-9703
Mailing Address - Street 1:3355 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4845
Mailing Address - Country:US
Mailing Address - Phone:203-381-9703
Mailing Address - Fax:203-381-9802
Practice Address - Street 1:3355 MAIN ST
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4845
Practice Address - Country:US
Practice Address - Phone:203-381-9703
Practice Address - Fax:203-381-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000899CT03OtherANTHEM BLUE CROSS BLUE SHIELD
CT42701395OtherBENEFIT CONCEPTS
CT000001470878OtherPRIVATE HEALTHCARE SYSTEMS
CT050001707CT01OtherBC BS
CT745717OtherCONNECTICARE
CT9812065OtherAETNA
CT183592OtherWELLCARE
CTNHS467OtherOXFORD
CTP4003952OtherOXFORD
CT42701395OtherGOLDEN RULE
CT050000899CT04OtherANTHEM BLUE CROSS BLUE SHIELD
CT12724992OtherMULTIPLAN
CT42701395OtherA C N
CT4298598OtherAETNA
CT42701395OtherGREAT WEST
CT42701395OtherGOLDEN RULE
CTD100000003Medicare PIN
CT9812065OtherAETNA
CT42701395OtherBENEFIT CONCEPTS