Provider Demographics
NPI:1669674412
Name:ANSONIA CHIROPRACTIC AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:ANSONIA CHIROPRACTIC AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SWIATOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-736-6356
Mailing Address - Street 1:44 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1818
Mailing Address - Country:US
Mailing Address - Phone:203-736-6356
Mailing Address - Fax:203-734-6781
Practice Address - Street 1:44 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1818
Practice Address - Country:US
Practice Address - Phone:203-736-6356
Practice Address - Fax:203-734-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1174618201Medicare ID - Type UnspecifiedINDIVIDUAL NPI