Healthcare Provider Details

I. General information

NPI: 1790801827
Provider Name (Legal Business Name): JOSEPH GIANNATTASIO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SHAW CHIROPRACTIC 136 WEST MAIN STREET - 2ND FLOOR
NEW BRITAIN CT
06051
US

IV. Provider business mailing address

SHAW CHIROPRACTIC GROUP 136 WEST MAIN STREET
NEW BRITAIN CT
06052-1315
US

V. Phone/Fax

Practice location:
  • Phone: 860-225-7429
  • Fax: 860-826-4765
Mailing address:
  • Phone: 860-225-7429
  • Fax: 860-826-4765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1430
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: