Provider Demographics
NPI:1710949524
Name:VINCENT, ERIC HENRY (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:HENRY
Last Name:VINCENT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 E HILL RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2119
Mailing Address - Country:US
Mailing Address - Phone:860-693-8567
Mailing Address - Fax:860-693-8567
Practice Address - Street 1:220 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1949
Practice Address - Country:US
Practice Address - Phone:860-269-3225
Practice Address - Fax:860-269-3227
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03646OtherMEDICARE GROUP PIN
CTC03646OtherMEDICARE GROUP PIN
CT350001505Medicare PIN