Healthcare Provider Details

I. General information

NPI: 1497317317
Provider Name (Legal Business Name): STEPHEN REDMON DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 MAIN ST
MIDDLETOWN CT
06457-2732
US

IV. Provider business mailing address

19 GRAND ST
MIDDLETOWN CT
06457-2705
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-6971
  • Fax: 860-343-7379
Mailing address:
  • Phone: 860-347-6971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4732
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9226
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2357
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: