Healthcare Provider Details

I. General information

NPI: 1982623955
Provider Name (Legal Business Name): MICHAEL VAJDA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 WASHINGTON ST
MIDDLETOWN CT
06457-2903
US

IV. Provider business mailing address

761 WASHINGTON ST
MIDDLETOWN CT
06457-2903
US

V. Phone/Fax

Practice location:
  • Phone: 860-343-0222
  • Fax: 860-343-1544
Mailing address:
  • Phone: 860-343-0222
  • Fax: 860-343-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number649
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: