Healthcare Provider Details

I. General information

NPI: 1780920983
Provider Name (Legal Business Name): CONNECTICUT CENTER FOR NATURAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SOUTH MAIN ST SUITE 200
MIDDLETOWN CT
06457
US

IV. Provider business mailing address

210 SOUTH MAIN ST SUITE 200
MIDDLETOWN CT
06457
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-8600
  • Fax: 860-347-8434
Mailing address:
  • Phone: 860-347-8600
  • Fax: 860-347-8434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000259
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000060
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000171
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000145
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000241
License Number StateCT
# 6
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000061
License Number StateCT

VIII. Authorized Official

Name: MICHAEL KANE
Title or Position: ND
Credential: ND
Phone: 860-347-8434