Provider Demographics
NPI:1598897738
Name:LYNN CARNAROLI CHIROPRACTIC CENTER OF NORWICH
Entity Type:Organization
Organization Name:LYNN CARNAROLI CHIROPRACTIC CENTER OF NORWICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNAROLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-886-9277
Mailing Address - Street 1:85 SACHEM ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-889-5812
Mailing Address - Fax:860-886-9247
Practice Address - Street 1:85 SACHEM ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-889-5812
Practice Address - Fax:860-886-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-11-03
Deactivation Date:2008-07-22
Deactivation Code:
Reactivation Date:2008-10-01
Provider Licenses
StateLicense IDTaxonomies
CT00586111N00000X
CT000586111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1770697179OtherNPI
CT004074233Medicaid
CT2370484OtherAETNA US HEALTHCARE
CT050000586CT01OtherBLUE CROSS BLUE SHIELD
CT050000586CT01OtherBLUE CROSS BLUE SHIELD
CTC01585Medicare Oscar/Certification