Healthcare Provider Details

I. General information

NPI: 1306065248
Provider Name (Legal Business Name): SOUTH WINDSOR NECK AND BACK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 SULLIVAN AVE
SOUTH WINDSOR CT
06074-2713
US

IV. Provider business mailing address

1330 SULLIVAN AVE
SOUTH WINDSOR CT
06074-2713
US

V. Phone/Fax

Practice location:
  • Phone: 860-644-2437
  • Fax: 860-644-8590
Mailing address:
  • Phone: 860-644-2437
  • Fax: 860-644-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number011490
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number001133
License Number StateCT

VIII. Authorized Official

Name: DR. ANDREW P GREGORY
Title or Position: OWNER MANAGER
Credential:
Phone: 860-644-2437