Provider Demographics
NPI:1649465998
Name:TREMBLAY, JUSTIN RONALD (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:RONALD
Last Name:TREMBLAY
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 1:10 PENDLETON DR
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248-1525
Mailing Address - Country:US
Mailing Address - Phone:860-228-1441
Mailing Address - Fax:
Practice Address - Street 1:10 PENDLETON DR
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248-1525
Practice Address - Country:US
Practice Address - Phone:860-228-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor