Provider Demographics
NPI:1659462307
Name:GROTON CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:GROTON CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MASCARO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-445-4148
Mailing Address - Street 1:1057 POQUONNOCK RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4220
Mailing Address - Country:US
Mailing Address - Phone:860-445-4148
Mailing Address - Fax:860-449-1375
Practice Address - Street 1:1057 POQUONNOCK RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4220
Practice Address - Country:US
Practice Address - Phone:860-445-4148
Practice Address - Fax:860-449-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000502111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1770503492OtherNPI NUMBER
CT1770503492OtherNPI NUMBER