Healthcare Provider Details

I. General information

NPI: 1932549953
Provider Name (Legal Business Name): DR BRIAN P CONNER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 FEDERAL RD
BROOKFIELD CT
06804-2406
US

IV. Provider business mailing address

366 FEDERAL RD
BROOKFIELD CT
06804-2406
US

V. Phone/Fax

Practice location:
  • Phone: 203-775-1819
  • Fax: 203-775-2028
Mailing address:
  • Phone: 203-775-1819
  • Fax: 203-775-2028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number1485
License Number StateCT

VIII. Authorized Official

Name: DR. BRIAN PATRICK CONNER
Title or Position: MEMBER
Credential: DC, CNS, CDN
Phone: 203-775-1819