Provider Demographics
NPI:1629132766
Name:NEAL, JOSEPH JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JAMES
Last Name:NEAL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WELLES ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033
Mailing Address - Country:US
Mailing Address - Phone:860-633-3525
Mailing Address - Fax:860-633-7186
Practice Address - Street 1:49 WELLES ST
Practice Address - Street 2:SUITE 207
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033
Practice Address - Country:US
Practice Address - Phone:860-633-3525
Practice Address - Fax:860-633-7186
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000167111NN1001X
CT167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
0511238OtherAETNA
732518OtherCONNECTICARE
P485802OtherOXFORD
050000167CT01OtherBLUE CROSS BLUE SHIELD
CT1023268810Medicare UPIN
050000167CT01OtherBLUE CROSS BLUE SHIELD