Healthcare Provider Details

I. General information

NPI: 1669464061
Provider Name (Legal Business Name): GARY J RADER DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 ARMORY RD
STRATFORD CT
06614-1702
US

IV. Provider business mailing address

95 ARMORY RD
STRATFORD CT
06614-1702
US

V. Phone/Fax

Practice location:
  • Phone: 203-377-6927
  • Fax: 203-381-0606
Mailing address:
  • Phone: 203-377-6927
  • Fax: 203-381-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY JOSEPH RADER
Title or Position: PRESIDENT(CHIROPRACTIC PHYSICIAN)
Credential: DC
Phone: 203-377-6927