Healthcare Provider Details

I. General information

NPI: 1851790679
Provider Name (Legal Business Name): MILDRED OXILAS DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 DIXWELL AVE APT D23
HAMDEN CT
06514-3146
US

IV. Provider business mailing address

1690 DIXWELL AVE APT D23
HAMDEN CT
06514-3146
US

V. Phone/Fax

Practice location:
  • Phone: 203-691-7504
  • Fax:
Mailing address:
  • Phone: 203-691-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001983
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: