Provider Demographics
NPI:1578872024
Name:PAPE CHIROPRACTIC & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:PAPE CHIROPRACTIC & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIANNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAPE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-739-3600
Mailing Address - Street 1:PO BOX 944
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-0944
Mailing Address - Country:US
Mailing Address - Phone:860-739-3600
Mailing Address - Fax:860-739-3400
Practice Address - Street 1:11 FREEDOM WAY
Practice Address - Street 2:UNIT B-01
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1041
Practice Address - Country:US
Practice Address - Phone:860-739-3600
Practice Address - Fax:860-739-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001857111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty