Healthcare Provider Details

I. General information

NPI: 1508101536
Provider Name (Legal Business Name): CHIROPRACTIC HEALTH CARE CENTER OF HAMDEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 OLD DIXWELL AVE
HAMDEN CT
06518-3138
US

IV. Provider business mailing address

2821 OLD DIXWELL AVE
HAMDEN CT
06518-3138
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-2821
  • Fax: 203-288-2854
Mailing address:
  • Phone: 203-288-2821
  • Fax: 203-288-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001421
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007661
License Number StateCT

VIII. Authorized Official

Name: DR. BRYAN WADE BARRY
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 203-288-2821