Provider Demographics
NPI:1578656583
Name:METZGER, JAMES M (DC,CCSP)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:METZGER
Suffix:
Gender:M
Credentials:DC,CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1726
Mailing Address - Country:US
Mailing Address - Phone:203-239-5980
Mailing Address - Fax:203-234-7056
Practice Address - Street 1:97 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1726
Practice Address - Country:US
Practice Address - Phone:203-239-5980
Practice Address - Fax:203-234-7056
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT733111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT727589OtherCONNECTICARE
CT050000733CT01OtherANTHEM BCBS
CT4096774Medicaid