Provider Demographics
NPI:1851735336
Name:DELUCIA CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:DELUCIA CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELUCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-740-1040
Mailing Address - Street 1:632 FEDERAL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2045
Mailing Address - Country:US
Mailing Address - Phone:203-740-1040
Mailing Address - Fax:203-740-1042
Practice Address - Street 1:632 FEDERAL RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2045
Practice Address - Country:US
Practice Address - Phone:203-740-1040
Practice Address - Fax:203-740-1042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty