Provider Demographics
NPI:1689798423
Name:BASSANI, JEAN (DC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:BASSANI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 MAIN ST
Mailing Address - Street 2:BLDG # 1
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2830
Mailing Address - Country:US
Mailing Address - Phone:203-261-0064
Mailing Address - Fax:203-261-0065
Practice Address - Street 1:755 MAIN ST
Practice Address - Street 2:BLDG # 1
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2830
Practice Address - Country:US
Practice Address - Phone:203-261-0064
Practice Address - Fax:203-261-0065
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001192111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor