Provider Demographics
NPI:1750586806
Name:BOULEVARD CHIROPRACTIC & WELLNESS CENTER
Entity type:Organization
Organization Name:BOULEVARD CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SCARINGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-236-9300
Mailing Address - Street 1:1329 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1603
Mailing Address - Country:US
Mailing Address - Phone:860-236-9300
Mailing Address - Fax:860-236-9306
Practice Address - Street 1:1329 BOULEVARD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1603
Practice Address - Country:US
Practice Address - Phone:860-236-9300
Practice Address - Fax:860-236-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU89625Medicare UPIN
CTC03741Medicare PIN