Provider Demographics
NPI:1649459827
Name:CLYNE CHIROPRACTIC & WELLNESS, LLC
Entity type:Organization
Organization Name:CLYNE CHIROPRACTIC & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-259-2124
Mailing Address - Street 1:1300 POST RD E
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5537
Mailing Address - Country:US
Mailing Address - Phone:203-259-2124
Mailing Address - Fax:203-259-2004
Practice Address - Street 1:1300 POST RD E
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5537
Practice Address - Country:US
Practice Address - Phone:203-259-2124
Practice Address - Fax:203-259-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03219Medicare PIN