Healthcare Provider Details

I. General information

NPI: 1255485892
Provider Name (Legal Business Name): INTEGRATED HEALTHCARE & SPORTS SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 STATE ST
NORTH HAVEN CT
06473-2245
US

IV. Provider business mailing address

42 STATE ST
NORTH HAVEN CT
06473-2245
US

V. Phone/Fax

Practice location:
  • Phone: 203-239-4404
  • Fax:
Mailing address:
  • Phone: 203-239-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number001490
License Number StateCT

VIII. Authorized Official

Name: DR. DANIEL M TERRAY, JR.
Title or Position: OWNER
Credential: DC
Phone: 203-239-4404