Provider Demographics
NPI:1770702870
Name:CHIROPRACTIC AND REHABILITATION CENTER OF CHESHIRE INC
Entity type:Organization
Organization Name:CHIROPRACTIC AND REHABILITATION CENTER OF CHESHIRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GALIETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-272-8960
Mailing Address - Street 1:441 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2141
Mailing Address - Country:US
Mailing Address - Phone:203-272-0573
Mailing Address - Fax:
Practice Address - Street 1:441 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2141
Practice Address - Country:US
Practice Address - Phone:203-272-0573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001254111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02411Medicare PIN