Healthcare Provider Details

I. General information

NPI: 1053772566
Provider Name (Legal Business Name): ELIJAH MANFREDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 STATE ROUTE 37
NEW FAIRFIELD CT
06812-5036
US

IV. Provider business mailing address

88 STATE ROUTE 37
NEW FAIRFIELD CT
06812-5036
US

V. Phone/Fax

Practice location:
  • Phone: 203-746-6551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2029
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: