Provider Demographics
NPI:1023155009
Name:CHIROPRACTIC HEALTH CENTER OF WILTON
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH CENTER OF WILTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:JONATHON
Authorized Official - Last Name:BOERNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT OR RPT
Authorized Official - Phone:203-834-1515
Mailing Address - Street 1:126 OLD RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897
Mailing Address - Country:US
Mailing Address - Phone:203-834-1515
Mailing Address - Fax:203-762-7210
Practice Address - Street 1:126 PIMPEWAUG RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897
Practice Address - Country:US
Practice Address - Phone:203-834-1515
Practice Address - Fax:203-762-7210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty