Provider Demographics
NPI:1639290539
Name:PRECISION CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PRECISION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:LORDAN
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:203-488-2033
Mailing Address - Street 1:454 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2965
Mailing Address - Country:US
Mailing Address - Phone:203-488-2033
Mailing Address - Fax:203-488-0233
Practice Address - Street 1:454 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2965
Practice Address - Country:US
Practice Address - Phone:203-488-2033
Practice Address - Fax:203-488-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU95895Medicare UPIN
CT350001259Medicare PIN
CT5932800001Medicare NSC