Healthcare Provider Details

I. General information

NPI: 1689088395
Provider Name (Legal Business Name): CENTER FOR NATURAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 ALBANY TPKE SUITE 10
CANTON CT
06019-2546
US

IV. Provider business mailing address

166 ALBANY TPKE SUITE 10
CANTON CT
06019-2546
US

V. Phone/Fax

Practice location:
  • Phone: 860-693-0255
  • Fax: 860-693-4250
Mailing address:
  • Phone: 860-693-0255
  • Fax: 860-693-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001489
License Number StateCT

VIII. Authorized Official

Name: DR. STEPHEN R KARPENKO
Title or Position: CHIROPRACTOR AND ACUPUNCTURIST
Credential: MD, ACCP
Phone: 860-693-0255