Healthcare Provider Details

I. General information

NPI: 1922066299
Provider Name (Legal Business Name): ANTHONY TORTORELLA JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 SPORT HILL RD
EASTON CT
06612-1825
US

IV. Provider business mailing address

267 SPORT HILL RD
EASTON CT
06612-1825
US

V. Phone/Fax

Practice location:
  • Phone: 203-371-6004
  • Fax: 203-372-2379
Mailing address:
  • Phone: 203-371-6004
  • Fax: 203-372-2379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1542
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: