Healthcare Provider Details

I. General information

NPI: 1366744922
Provider Name (Legal Business Name): O'MALLEY CHIROPRACTIC HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 BEAVER ROAD SUITE 2A
WETHERSFIELD CT
06109
US

IV. Provider business mailing address

78 BEAVER ROAD SUITE 2A
WETHERSFIELD CT
06109
US

V. Phone/Fax

Practice location:
  • Phone: 860-257-9400
  • Fax: 860-257-7169
Mailing address:
  • Phone: 860-257-9400
  • Fax: 860-257-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCT000731
License Number StateCT

VIII. Authorized Official

Name: MARK E. O'MALLEY
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 860-257-9400