Healthcare Provider Details

I. General information

NPI: 1346867629
Provider Name (Legal Business Name): ALAN AMENDOLA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CORPORATE DR UNIT B104
TRUMBULL CT
06611-6346
US

IV. Provider business mailing address

755 MAIN ST STE 1
MONROE CT
06468-2830
US

V. Phone/Fax

Practice location:
  • Phone: 203-590-3407
  • Fax:
Mailing address:
  • Phone: 203-261-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2186
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: