Provider Demographics
NPI:1639390545
Name:CALDARONE CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:CALDARONE CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CALDARONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-488-1105
Mailing Address - Street 1:239 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3020
Mailing Address - Country:US
Mailing Address - Phone:203-488-1105
Mailing Address - Fax:203-488-8113
Practice Address - Street 1:239 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3020
Practice Address - Country:US
Practice Address - Phone:203-488-1105
Practice Address - Fax:203-488-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1009111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001009CT02OtherANTHEM PROVIDER ID
CTCT01009OtherLANDMARK PROVIDER ID
CT3759643OtherAETNA ID
CTP429018OtherOXFORD ID
CTP429018OtherOXFORD ID