Provider Demographics
NPI:1780826099
Name:MANCINI CHIROPRACTIC,LLC
Entity Type:Organization
Organization Name:MANCINI CHIROPRACTIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANCINI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-262-6347
Mailing Address - Street 1:440 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-4201
Mailing Address - Country:US
Mailing Address - Phone:203-262-6347
Mailing Address - Fax:203-267-6155
Practice Address - Street 1:440 MAIN ST S
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4201
Practice Address - Country:US
Practice Address - Phone:203-262-6347
Practice Address - Fax:203-267-6155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU01931Medicare UPIN