Healthcare Provider Details

I. General information

NPI: 1548536709
Provider Name (Legal Business Name): BRETT DYLAN BARBER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2012
Last Update Date: 03/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 PROSPECT HILL RD # C SOFIA'S PLAZA II
EAST WINDSOR CT
06088-9546
US

IV. Provider business mailing address

122 PROSPECT HILL RD # C SOFIA'S PLAZA II
EAST WINDSOR CT
06088-9546
US

V. Phone/Fax

Practice location:
  • Phone: 860-627-8868
  • Fax: 860-627-9237
Mailing address:
  • Phone: 860-627-8868
  • Fax: 860-627-9237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001899
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: