Provider Demographics
NPI:1902217029
Name:CENTRAL CONNECTICUT CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CENTRAL CONNECTICUT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIGI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIRUBBA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-272-3239
Mailing Address - Street 1:391 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2523
Mailing Address - Country:US
Mailing Address - Phone:203-272-3239
Mailing Address - Fax:203-272-2224
Practice Address - Street 1:391 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2523
Practice Address - Country:US
Practice Address - Phone:203-272-3239
Practice Address - Fax:203-272-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350000726Medicare PIN