Provider Demographics
NPI:1952548166
Name:1700 DIXWELL HEALTHCARE GROUP, LLC
Entity Type:Organization
Organization Name:1700 DIXWELL HEALTHCARE GROUP, LLC
Other - Org Name:FIRST CARE PHYSICAL MEDICINE & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BARONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:203-389-6188
Mailing Address - Street 1:1700 DIXWELL AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-3147
Mailing Address - Country:US
Mailing Address - Phone:203-397-2225
Mailing Address - Fax:203-288-9775
Practice Address - Street 1:1700 DIXWELL AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-3147
Practice Address - Country:US
Practice Address - Phone:203-397-2225
Practice Address - Fax:203-288-9775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350001016Medicare PIN