Provider Demographics
NPI:1801036496
Name:CHIROPRACTIC HEALTH CENTER OF GLASTONBURY, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH CENTER OF GLASTONBURY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEFRANCESCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-657-8800
Mailing Address - Street 1:2934 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1027
Mailing Address - Country:US
Mailing Address - Phone:860-657-8800
Mailing Address - Fax:860-633-7252
Practice Address - Street 1:2934 MAIN ST,
Practice Address - Street 2:SUITE 1
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1027
Practice Address - Country:US
Practice Address - Phone:860-657-8800
Practice Address - Fax:860-633-7252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOV4394OtherHEALTHNET/LANDMARK HEALTHCARE
CT0229775OtherUNITED HEALTHCARE
CT050000986CT01OtherANTHEM BLUECROSS/BLUESHIELD
CT451983OtherAETNA
CT050000986CT01OtherANTHEM BLUECROSS/BLUESHIELD