Healthcare Provider Details

I. General information

NPI: 1972713162
Provider Name (Legal Business Name): SPINE & PAIN REHABILITATION CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
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: 860-677-7246
  • Fax: 860-677-1972
Mailing address:
  • Phone: 860-677-7246
  • Fax: 860-677-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001383
License Number StateCT

VIII. Authorized Official

Name: GARY F IERNA
Title or Position: PRESIDENT
Credential: D.C.
Phone: 860-677-7246