Healthcare Provider Details

I. General information

NPI: 1992752596
Provider Name (Legal Business Name): EASTERN SHORE CHIROPRACTIC CENTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 COLMAN ST
NEW LONDON CT
06320-3713
US

IV. Provider business mailing address

377 COLMAN ST
NEW LONDON CT
06320-3713
US

V. Phone/Fax

Practice location:
  • Phone: 860-444-6363
  • Fax: 860-443-3314
Mailing address:
  • Phone: 860-444-6363
  • Fax: 860-443-3314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MARY LAVIN MOORADIAN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 860-444-6363