Provider Demographics
NPI:1659458560
Name:NARDI, BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:NARDI
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 1:195 W MAIN ST
Mailing Address - Street 2:SUITE 20
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3685
Mailing Address - Country:US
Mailing Address - Phone:860-677-6401
Mailing Address - Fax:860-677-6873
Practice Address - Street 1:195 W MAIN ST
Practice Address - Street 2:SUITE 20
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3685
Practice Address - Country:US
Practice Address - Phone:860-677-6401
Practice Address - Fax:860-677-6873
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001448CT01OtherBLUECROSSBLUESHIELD
CT050001448CT01OtherBLUECROSSBLUESHIELD
CT350001213Medicare ID - Type Unspecified