Provider Demographics
NPI:1811717457
Name:MILFORD SPORT & SPINE LLC
Entity type:Organization
Organization Name:MILFORD SPORT & SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DANIELLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-589-2782
Mailing Address - Street 1:552 TREAT LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2740
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:213 NEW HAVEN AVE FL 1
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4830
Practice Address - Country:US
Practice Address - Phone:203-783-9720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center