Provider Demographics
NPI:1598055683
Name:MICHAEL VAJDA, D.C., L.L.C.
Entity Type:Organization
Organization Name:MICHAEL VAJDA, D.C., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAJDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-343-0222
Mailing Address - Street 1:761 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2903
Mailing Address - Country:US
Mailing Address - Phone:860-343-0222
Mailing Address - Fax:860-343-1544
Practice Address - Street 1:761 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-2903
Practice Address - Country:US
Practice Address - Phone:860-343-0222
Practice Address - Fax:860-343-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350000460Medicare PIN