Healthcare Provider Details

I. General information

NPI: 1932194842
Provider Name (Legal Business Name): TIMOTHY J LEFFERT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 FOXON RD
EAST HAVEN CT
06513-1830
US

IV. Provider business mailing address

943 FOXON RD
EAST HAVEN CT
06513-1830
US

V. Phone/Fax

Practice location:
  • Phone: 203-466-1769
  • Fax: 203-467-2265
Mailing address:
  • Phone: 203-466-1769
  • Fax: 203-467-2265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number000467
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: