Provider Demographics
NPI:1518196583
Name:MARC W PLATT DC DBA/ COMMUNITY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:MARC W PLATT DC DBA/ COMMUNITY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:W
Authorized Official - Last Name:PLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-239-2323
Mailing Address - Street 1:336 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1306
Mailing Address - Country:US
Mailing Address - Phone:203-239-2323
Mailing Address - Fax:203-239-3325
Practice Address - Street 1:336 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1306
Practice Address - Country:US
Practice Address - Phone:203-239-2323
Practice Address - Fax:203-239-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000411111N00000X
CT003156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT23372Medicare UPIN
CT350000305Medicare PIN