Provider Demographics
NPI:1841233681
Name:PRADO, JAMES T (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:PRADO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1579 STRAITS TPKE STE E
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1835
Mailing Address - Country:US
Mailing Address - Phone:203-598-0700
Mailing Address - Fax:877-345-6922
Practice Address - Street 1:1579 STRAITS TPKE STE E
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1835
Practice Address - Country:US
Practice Address - Phone:203-598-0700
Practice Address - Fax:877-345-6922
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT605111NS0005X
CT000605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02702OtherMEDICARE GROUP #
CT350000411Medicare ID - Type Unspecified
CTC02702OtherMEDICARE GROUP #