Provider Demographics
NPI:1518236462
Name:OLYMPIC HEALTH AND SPORTS THERAPY PC
Entity Type:Organization
Organization Name:OLYMPIC HEALTH AND SPORTS THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-287-8524
Mailing Address - Street 1:2440 WHITNEY AVE
Mailing Address - Street 2:# 209
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3222
Mailing Address - Country:US
Mailing Address - Phone:203-287-8524
Mailing Address - Fax:203-287-2452
Practice Address - Street 1:2440 WHITNEY AVE
Practice Address - Street 2:# 209
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3222
Practice Address - Country:US
Practice Address - Phone:203-287-8524
Practice Address - Fax:203-287-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001630111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty