Provider Demographics
NPI:1508030487
Name:STAFFORD FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:STAFFORD FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-684-2227
Mailing Address - Street 1:P.O. BOX 110
Mailing Address - Street 2:
Mailing Address - City:STAFFORD SPRINGS
Mailing Address - State:CT
Mailing Address - Zip Code:06076
Mailing Address - Country:US
Mailing Address - Phone:860-684-2227
Mailing Address - Fax:860-684-6104
Practice Address - Street 1:72 WEST STAFFORD ROAD
Practice Address - Street 2:SUITE A-3
Practice Address - City:STAFFORD SPRINGS
Practice Address - State:CT
Practice Address - Zip Code:06076
Practice Address - Country:US
Practice Address - Phone:860-684-2227
Practice Address - Fax:860-684-6104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C03931Medicare PIN