Provider Demographics
NPI:1255596474
Name:BRASS CITY CHIROPRACTIC CENTER, LLC
Entity type:Organization
Organization Name:BRASS CITY CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:H
Authorized Official - Last Name:TSCHEPPE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-757-7246
Mailing Address - Street 1:11 SCOVILL ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1107
Mailing Address - Country:US
Mailing Address - Phone:203-757-7246
Mailing Address - Fax:203-757-7247
Practice Address - Street 1:11 SCOVILL ST
Practice Address - Street 2:SUITE 104
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1107
Practice Address - Country:US
Practice Address - Phone:203-757-7246
Practice Address - Fax:203-757-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1455111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350001164Medicare PIN
U88486Medicare UPIN