Healthcare Provider Details

I. General information

NPI: 1649209123
Provider Name (Legal Business Name): BRIAN J. HENNINGER N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 POST RD STE 301
FAIRFIELD CT
06824-6016
US

IV. Provider business mailing address

1305 POST RD STE 301
FAIRFIELD CT
06824-6016
US

V. Phone/Fax

Practice location:
  • Phone: 203-255-4325
  • Fax:
Mailing address:
  • Phone: 203-255-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number000248
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number000248
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: