MEDICARE: JUDE VINCENT LOMBARDI DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	000306	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10445959	OTHER		CAQH

General Provider Information

NPI Number	:	1639163140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDE VINCENT LOMBARDI DC

Provider Business Mailing Address
First Line	:	53 WINTONBURY MALL
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-2411
Country	:	US
Telephone Number	:	860-242-5400
Fax Number	:	860-286-0837

Provider Business Practice Location Address
First Line	:	53 WINTONBURY MALL
Second Line	:
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-2411
Country	:	US
Telephone Number	:	860-242-5400
Fax Number	:	860-286-0837

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	02/26/2008

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Directions to “ JUDE VINCENT LOMBARDI DC” Practice Location

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