Provider Demographics
NPI:1275603367
Name:MONACO, LORI JANE (DC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:JANE
Last Name:MONACO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-4016
Mailing Address - Country:US
Mailing Address - Phone:203-366-7429
Mailing Address - Fax:203-330-0408
Practice Address - Street 1:1227 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4016
Practice Address - Country:US
Practice Address - Phone:203-366-7429
Practice Address - Fax:203-330-0408
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001416111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU77522Medicare UPIN