Provider Demographics
NPI:1336363464
Name:SPITZ, DAVID M
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:SPITZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PINE ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6950
Mailing Address - Country:US
Mailing Address - Phone:860-583-4346
Mailing Address - Fax:860-583-0667
Practice Address - Street 1:22 PINE ST
Practice Address - Street 2:SUITE 216
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6950
Practice Address - Country:US
Practice Address - Phone:860-583-4346
Practice Address - Fax:860-583-0667
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTUPIN T23070Medicare UPIN
CT350000661Medicare ID - Type Unspecified