Provider Demographics
NPI:1467444562
Name:MORMILE, JOHN LOUIS (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LOUIS
Last Name:MORMILE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06480-1861
Mailing Address - Country:US
Mailing Address - Phone:860-342-7277
Mailing Address - Fax:860-342-7281
Practice Address - Street 1:234 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:CT
Practice Address - Zip Code:06480-1861
Practice Address - Country:US
Practice Address - Phone:860-342-7277
Practice Address - Fax:860-342-7281
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT540111N00000X
FLCH0004991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00540OtherLANDMARK
CT050000540CT03OtherANTHEM
CT2V0679OtherHEALTHNET
CTNHS338OtherOXFORD
CT4212157OtherAETNA
CT061632199-01OtherPRISM