Provider Demographics
NPI:1639163140
Name:LOMBARDI, JUDE VINCENT (DC)
Entity Type:Individual
Prefix:
First Name:JUDE
Middle Name:VINCENT
Last Name:LOMBARDI
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 1:53 WINTONBURY MALL
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2411
Mailing Address - Country:US
Mailing Address - Phone:860-242-5400
Mailing Address - Fax:860-286-0837
Practice Address - Street 1:53 WINTONBURY MALL
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2411
Practice Address - Country:US
Practice Address - Phone:860-242-5400
Practice Address - Fax:860-286-0837
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
10445959OtherCAQH
T22154Medicare UPIN