Provider Demographics
NPI:1942348453
Name:CHIROPRACTIC CARE OF WINDSOR LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE OF WINDSOR LLC
Other - Org Name:CHIROPRACTIC CARE OF WINDSOR LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:R
Authorized Official - Last Name:IALACCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-688-6699
Mailing Address - Street 1:88 DAY HILL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2200
Mailing Address - Country:US
Mailing Address - Phone:860-688-6699
Mailing Address - Fax:860-683-2113
Practice Address - Street 1:88 DAY HILL RD STE 102
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2200
Practice Address - Country:US
Practice Address - Phone:860-688-6699
Practice Address - Fax:860-683-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT22682Medicare UPIN