Provider Demographics
NPI:1891857231
Name:SAMOSKA, RICHARD (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:SAMOSKA
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 1:400 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06485
Mailing Address - Country:US
Mailing Address - Phone:203-483-7778
Mailing Address - Fax:203-481-0234
Practice Address - Street 1:400 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06485
Practice Address - Country:US
Practice Address - Phone:203-483-7778
Practice Address - Fax:203-481-0234
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001507111N00000X
CT1507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
350001499Medicare UPIN