Provider Demographics
NPI:1598852758
Name:EAST WEST CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:EAST WEST CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DEVEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-446-9700
Mailing Address - Street 1:1353 GOLD STAR HWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2739
Mailing Address - Country:US
Mailing Address - Phone:860-446-9700
Mailing Address - Fax:860-326-5728
Practice Address - Street 1:1353 GOLD STAR HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-2739
Practice Address - Country:US
Practice Address - Phone:860-446-9700
Practice Address - Fax:860-326-5728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001172CT02OtherBLUECROSSBLUESHIELD
CT350001346Medicare ID - Type Unspecified
CT050001172CT02OtherBLUECROSSBLUESHIELD