Provider Demographics
NPI:1831125475
Name:SIMSBURY FAMILY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:SIMSBURY FAMILY CHIROPRACTIC CENTER
Other - Org Name:SIMSBURY CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-651-3355
Mailing Address - Street 1:499 HOPMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2412
Mailing Address - Country:US
Mailing Address - Phone:860-651-3355
Mailing Address - Fax:860-408-9648
Practice Address - Street 1:499 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2412
Practice Address - Country:US
Practice Address - Phone:860-651-3355
Practice Address - Fax:860-408-9648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001017CT01OtherANTHEM BCBS OF CT
CT050001017CT01OtherANTHEM BCBS OF CT
CTC03373Medicare ID - Type UnspecifiedGROUP NUMBER