Healthcare Provider Details

I. General information

NPI: 1619160256
Provider Name (Legal Business Name): GODFREY CHIROPRACTIC & REHABILIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 FARMINGTON AVE
FARMINGTON CT
06032-1949
US

IV. Provider business mailing address

220 FARMINGTON AVE
FARMINGTON CT
06032-1949
US

V. Phone/Fax

Practice location:
  • Phone: 860-232-3277
  • Fax: 860-232-6277
Mailing address:
  • Phone: 860-232-3277
  • Fax: 860-232-6277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001361
License Number StateCT

VIII. Authorized Official

Name: DR. MARK EAMON GODFREY
Title or Position: OWNER/SOLE PROPRIETER
Credential: D.C., M.S.
Phone: 860-232-3277