Provider Demographics
NPI:1821308578
Name:CHIROPRACTIC KINESIOLOGISTS, LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC KINESIOLOGISTS, LLC
Other - Org Name:CHIROPRACTIC KINESIOLOGISTS,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:CUCOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-879-1385
Mailing Address - Street 1:250 WOLCOTT RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2634
Mailing Address - Country:US
Mailing Address - Phone:203-879-1385
Mailing Address - Fax:203-879-1856
Practice Address - Street 1:250 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2634
Practice Address - Country:US
Practice Address - Phone:203-879-1385
Practice Address - Fax:203-879-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000165OtherCT LICENSE
CT1982743092OtherNPI