Provider Demographics
NPI:1811408412
Name:CONNECTICUT CHIROPRACTIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:CONNECTICUT CHIROPRACTIC ASSOCIATES LLC
Other - Org Name:HEALTH DYNAMIX CHIROPRACTIC AND INTEGRATIVE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-845-5211
Mailing Address - Street 1:146 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4218
Mailing Address - Country:US
Mailing Address - Phone:860-845-5211
Mailing Address - Fax:
Practice Address - Street 1:146 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4218
Practice Address - Country:US
Practice Address - Phone:860-845-5211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004221389Medicaid