Healthcare Provider Details

I. General information

NPI: 1932312782
Provider Name (Legal Business Name): DOUGLAS JOHN DE MASSA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EAST AVE SUITE 336
NORWALK CT
06851-5014
US

IV. Provider business mailing address

359 BENNETTS FARM RD
RIDGEFIELD CT
06877-2110
US

V. Phone/Fax

Practice location:
  • Phone: 203-866-6000
  • Fax:
Mailing address:
  • Phone: 203-894-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number001397
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: