Provider Demographics
NPI:1710159736
Name:STAMFORD SPORTS & SPINE,PC
Entity Type:Organization
Organization Name:STAMFORD SPORTS & SPINE,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOMICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-355-2225
Mailing Address - Street 1:1 ATLANTIC ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-2482
Mailing Address - Country:US
Mailing Address - Phone:203-355-2225
Mailing Address - Fax:203-355-2235
Practice Address - Street 1:1 ATLANTIC ST
Practice Address - Street 2:SUITE 201
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2482
Practice Address - Country:US
Practice Address - Phone:203-355-2225
Practice Address - Fax:203-355-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty