Provider Demographics
NPI:1780855783
Name:METZGER CHIROPRACTIC CENTER,LLC
Entity Type:Organization
Organization Name:METZGER CHIROPRACTIC CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-239-5980
Mailing Address - Street 1:15 MAIDEN LN
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2306
Mailing Address - Country:US
Mailing Address - Phone:203-239-5980
Mailing Address - Fax:203-234-7056
Practice Address - Street 1:15 MAIDEN LN
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2306
Practice Address - Country:US
Practice Address - Phone:203-239-5980
Practice Address - Fax:203-234-7056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT733261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4096774Medicaid
CT350000542Medicare PIN