Healthcare Provider Details

I. General information

NPI: 1235558461
Provider Name (Legal Business Name): CARBONE CHIROPRACTIC CENTER DBA SOUTHSIDE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82-86 WOLCOTT HILL RD SUITE 102
WETHERSFIELD CT
06109-1252
US

IV. Provider business mailing address

82-86 WOLCOTT HILL RD SUITE 102
WETHERSFIELD CT
06109-1252
US

V. Phone/Fax

Practice location:
  • Phone: 860-436-3151
  • Fax: 860-436-3277
Mailing address:
  • Phone: 860-436-3151
  • Fax: 860-436-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: GUY CARBONE
Title or Position: OWNER
Credential: DC
Phone: 860-748-9090