Provider Demographics
NPI:1134544844
Name:GAUDREAU, JAMES DAVID (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:GAUDREAU
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 1:160 ROUTE 171
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281-3123
Mailing Address - Country:US
Mailing Address - Phone:860-963-2289
Mailing Address - Fax:
Practice Address - Street 1:160 ROUTE 171
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281-3123
Practice Address - Country:US
Practice Address - Phone:860-963-2289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor