Provider Demographics
NPI:1245549633
Name:DAVID YURGAITIS
Entity type:Organization
Organization Name:DAVID YURGAITIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:YURGAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-879-9681
Mailing Address - Street 1:800 WOODTICK RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2521
Mailing Address - Country:US
Mailing Address - Phone:203-879-9681
Mailing Address - Fax:
Practice Address - Street 1:800 WOODTICK RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2521
Practice Address - Country:US
Practice Address - Phone:203-879-9372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-02
Last Update Date:2010-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1902945017OtherNPI