Provider Demographics
NPI:1245347400
Name:ORTELLI, DAMIAN ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:ERIC
Last Name:ORTELLI
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 1:1435 BEDFORD STREET
Mailing Address - Street 2:SUITE 1R
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5225
Mailing Address - Country:US
Mailing Address - Phone:203-348-8383
Mailing Address - Fax:203-961-1567
Practice Address - Street 1:1435 BEDFORD STREET
Practice Address - Street 2:SUITE 1R
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5225
Practice Address - Country:US
Practice Address - Phone:203-348-8383
Practice Address - Fax:203-961-1567
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT0001613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTV04678Medicare UPIN