Provider Demographics
NPI:1881710853
Name:POMPERAUG CHIROPRACTIC AND HOLISTIC CENTER, PC
Entity type:Organization
Organization Name:POMPERAUG CHIROPRACTIC AND HOLISTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:PRADO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-264-3583
Mailing Address - Street 1:3 POMPERAUG OFFICE PARK
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2287
Mailing Address - Country:US
Mailing Address - Phone:203-264-3583
Mailing Address - Fax:
Practice Address - Street 1:3 POMPERAUG OFFICE PARK
Practice Address - Street 2:SUITE 103
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2287
Practice Address - Country:US
Practice Address - Phone:203-264-3583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty