Provider Demographics
NPI:1710987789
Name:LAUB, MOSHE (DC)
Entity Type:Individual
Prefix:DR
First Name:MOSHE
Middle Name:
Last Name:LAUB
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 1:345 N MAIN ST
Mailing Address - Street 2:SUITE 322
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2515
Mailing Address - Country:US
Mailing Address - Phone:860-232-5556
Mailing Address - Fax:860-232-5557
Practice Address - Street 1:345 N MAIN ST
Practice Address - Street 2:SUITE 322
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2515
Practice Address - Country:US
Practice Address - Phone:860-232-5556
Practice Address - Fax:860-232-5557
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11443110OtherCAQH
CT050001568CT01OtherBC/BS
CTV03974Medicare UPIN