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General NPI Number Information
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NPI Number | 1023102209
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Entity Type | Organization
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Legal Business Name | PHYSICAL MEDICINE AND CHIROPRACTIC CENTER LORELEI DAVIDSON M.D. MARC K
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 03/11/2009
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Provider Practice Location Address
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Address Line | 1867 SUMMER ST
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City | STAMFORD
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State | CT
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Zip | 06905-5016
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Country | US
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Telephone | 203-975-7000
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Fax | 203-975-0876
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Provider Business Mailing Address
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Address Line | 1867 SUMMER ST
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City | STAMFORD
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State | CT
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Zip | 06905-5016
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Country | US
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Telephone | 203-975-7000
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Fax | 203-975-0876
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARC DAVID KIRSHNER
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Credential | D.C.
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Telephone | 203-975-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 044106
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License Number State | CT
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