Provider Demographics
NPI:1336174978
Name:WESTPORT CHIROPRACTIC OFFICE
Entity Type:Organization
Organization Name:WESTPORT CHIROPRACTIC OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-227-4474
Mailing Address - Street 1:256 POST RD E
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3620
Mailing Address - Country:US
Mailing Address - Phone:203-227-4474
Mailing Address - Fax:203-227-8384
Practice Address - Street 1:256 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3620
Practice Address - Country:US
Practice Address - Phone:203-227-4474
Practice Address - Fax:203-227-8384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty