Provider Demographics
NPI:1598063455
Name:SOUTHERN CONNECTICUT MUSCLE AND JOINT PERFORMANCE CHIROPRACTIC
Entity Type:Organization
Organization Name:SOUTHERN CONNECTICUT MUSCLE AND JOINT PERFORMANCE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARMAND
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGLIARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-640-6302
Mailing Address - Street 1:491 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3505
Mailing Address - Country:US
Mailing Address - Phone:203-640-6302
Mailing Address - Fax:203-433-4277
Practice Address - Street 1:491 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3505
Practice Address - Country:US
Practice Address - Phone:203-640-6302
Practice Address - Fax:203-433-4277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001874111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty