Provider Demographics
NPI:1841495447
Name:PLAINVILLE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:PLAINVILLE CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACS
Authorized Official - Phone:860-793-6824
Mailing Address - Street 1:43 EAST ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2308
Mailing Address - Country:US
Mailing Address - Phone:860-793-6824
Mailing Address - Fax:860-793-6824
Practice Address - Street 1:43 EAST ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2308
Practice Address - Country:US
Practice Address - Phone:860-793-6824
Practice Address - Fax:860-793-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT 78358Medicare UPIN
CT350000473Medicare ID - Type Unspecified