Provider Demographics
NPI:1518369552
Name:CUTTING EDGE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CUTTING EDGE CHIROPRACTIC LLC
Other - Org Name:CUTTING EDGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:CUTTING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-454-0942
Mailing Address - Street 1:387 MERROW RD
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3935
Mailing Address - Country:US
Mailing Address - Phone:860-454-0942
Mailing Address - Fax:
Practice Address - Street 1:387 MERROW RD
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3935
Practice Address - Country:US
Practice Address - Phone:860-454-0942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty