Provider Demographics
NPI:1922387125
Name:BETHEL CHIROPRACTIC AND SPORTS THERAPY, LLC
Entity Type:Organization
Organization Name:BETHEL CHIROPRACTIC AND SPORTS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CHOJNACKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-748-9900
Mailing Address - Street 1:6A ELIZABETH ST.
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-2100
Mailing Address - Country:US
Mailing Address - Phone:203-748-9900
Mailing Address - Fax:203-748-9800
Practice Address - Street 1:6A ELIZABETH ST.
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-2100
Practice Address - Country:US
Practice Address - Phone:203-748-9900
Practice Address - Fax:203-748-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU85006Medicare UPIN