Provider Demographics
NPI:1770684862
Name:MILL PLAIN CENTER FOR CHIROPRACTIC & WHOLICTIC HEALTH
Entity type:Organization
Organization Name:MILL PLAIN CENTER FOR CHIROPRACTIC & WHOLICTIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-790-9563
Mailing Address - Street 1:4B CHRISTOPHER COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7352
Mailing Address - Country:US
Mailing Address - Phone:203-790-9563
Mailing Address - Fax:203-778-6612
Practice Address - Street 1:4B CHRISTOPHER COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7352
Practice Address - Country:US
Practice Address - Phone:203-790-9563
Practice Address - Fax:203-778-6612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT240111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000240CT02OtherANTHEM
CT050000240CT02OtherANTHEM
CT350000723Medicare ID - Type Unspecified