Healthcare Provider Details

I. General information

NPI: 1598833162
Provider Name (Legal Business Name): NCCFCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122CPROSPECT HILL RD
EAST WINDSOR CT
06088
US

IV. Provider business mailing address

122CPROSPECT HILL RD
EAST WINDSOR CT
06088
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1611
License Number StateCT

VIII. Authorized Official

Name: DR. MICHAEL CRAWFORD
Title or Position: DOCTOR
Credential: DC
Phone: 860-627-8868