Provider Demographics
NPI:1508101536
Name:CHIROPRACTIC HEALTH CARE CENTER OF HAMDEN, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH CARE CENTER OF HAMDEN, LLC
Other - Org Name:HEALTH CARE CENTER OF HAMDEN, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-288-2821
Mailing Address - Street 1:2821 OLD DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3138
Mailing Address - Country:US
Mailing Address - Phone:203-288-2821
Mailing Address - Fax:203-288-2821
Practice Address - Street 1:2821 OLD DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3138
Practice Address - Country:US
Practice Address - Phone:203-288-2821
Practice Address - Fax:203-288-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001421111N00000X
CT007661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty