Provider Demographics
NPI:1689811606
Name:CONNECTICUT CHIROPRACTIC FAMILY WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:CONNECTICUT CHIROPRACTIC FAMILY WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-648-2259
Mailing Address - Street 1:469 BUCKLAND RD
Mailing Address - Street 2:STE D
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3737
Mailing Address - Country:US
Mailing Address - Phone:860-648-2259
Mailing Address - Fax:
Practice Address - Street 1:469 BUCKLAND RD
Practice Address - Street 2:STE D
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-3737
Practice Address - Country:US
Practice Address - Phone:860-648-2259
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty