Provider Demographics
NPI:1720222300
Name:MINIACI CHIROPRACTIC AND ACUPUNCTURE CENTER LLC
Entity Type:Organization
Organization Name:MINIACI CHIROPRACTIC AND ACUPUNCTURE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MINIACI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-469-5210
Mailing Address - Street 1:53 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-2315
Mailing Address - Country:US
Mailing Address - Phone:203-469-5210
Mailing Address - Fax:203-468-8598
Practice Address - Street 1:53 HIGH ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-2315
Practice Address - Country:US
Practice Address - Phone:203-469-5210
Practice Address - Fax:203-468-8598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004128725Medicaid
CTD100159966Medicare UPIN