Healthcare Provider Details

I. General information

NPI: 1730338443
Provider Name (Legal Business Name): MICHAEL MCGLYNN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DARBROOK RD
WESTPORT CT
06880-3611
US

IV. Provider business mailing address

5 DARBROOK RD
WESTPORT CT
06880-3611
US

V. Phone/Fax

Practice location:
  • Phone: 203-226-7239
  • Fax: 203-226-7291
Mailing address:
  • Phone: 203-226-7239
  • Fax: 203-226-7291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number000990
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: