Healthcare Provider Details

I. General information

NPI: 1952412751
Provider Name (Legal Business Name): KEVIN RAYMOND BELLOWS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 LINDEMAN DR
TRUMBULL CT
06611-4782
US

IV. Provider business mailing address

25 LINDEMAN DR
TRUMBULL CT
06611-4782
US

V. Phone/Fax

Practice location:
  • Phone: 203-373-0315
  • Fax: 203-373-0367
Mailing address:
  • Phone: 203-373-0315
  • Fax: 203-373-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number000584
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: