Provider Demographics
NPI:1669674768
Name:ALEXANDER AND GRENON CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:ALEXANDER AND GRENON CHIROPRACTIC CENTER PC
Other - Org Name:ALEXANDER GRENON CHIR
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAITKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-272-4513
Mailing Address - Street 1:677 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:677S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3158
Practice Address - Country:US
Practice Address - Phone:203-272-4513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01098Medicare PIN