Healthcare Provider Details

I. General information

NPI: 1962690834
Provider Name (Legal Business Name): BAVARO CHIROPRACTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WHITE OAK RD
WOODBURY CT
06798-2832
US

IV. Provider business mailing address

2 WHITE OAK RD
WOODBURY CT
06798-2832
US

V. Phone/Fax

Practice location:
  • Phone: 203-263-2720
  • Fax:
Mailing address:
  • Phone: 203-263-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number832
License Number StateCT

VIII. Authorized Official

Name: KAREN BAVARO
Title or Position: PRESIDENT
Credential: DC
Phone: 203-263-2720