Provider Demographics
NPI:1720140718
Name:CONNAUGHTY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:CONNAUGHTY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:CONNAUGHTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-388-1654
Mailing Address - Street 1:142 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1548
Mailing Address - Country:US
Mailing Address - Phone:860-388-1654
Mailing Address - Fax:860-388-6748
Practice Address - Street 1:142 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1548
Practice Address - Country:US
Practice Address - Phone:860-388-1654
Practice Address - Fax:860-388-6748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01641Medicare ID - Type Unspecified