Provider Demographics
NPI:1629081690
Name:CT SPINE AND DISC CENTER LLC
Entity Type:Organization
Organization Name:CT SPINE AND DISC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:BELLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-633-8756
Mailing Address - Street 1:30 HEBRON AVE
Mailing Address - Street 2:#C DERR PLAZA
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4211
Mailing Address - Country:US
Mailing Address - Phone:860-633-8756
Mailing Address - Fax:860-633-8757
Practice Address - Street 1:30 HEBRON AVE
Practice Address - Street 2:#C DERR PLAZA
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4211
Practice Address - Country:US
Practice Address - Phone:860-633-8756
Practice Address - Fax:860-633-8757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03372Medicare ID - Type Unspecified