Provider Demographics
NPI:1215964705
Name:VINCENT, CHERYL (DC)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:VINCENT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:FITCH-SOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:499 HOPMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2412
Mailing Address - Country:US
Mailing Address - Phone:860-651-3355
Mailing Address - Fax:860-408-9648
Practice Address - Street 1:499 HOPMEADOW ST
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070-2412
Practice Address - Country:US
Practice Address - Phone:860-651-3355
Practice Address - Fax:860-408-9648
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001017111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001017CT01OtherANTHEM BC/BS OF CT
CTU41907Medicare UPIN