=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043426687
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEJIAS HEALTH & WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 07/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 OLD PARK LANE RD SUITE 3
-----------------------------------------------------
City | NEW MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06776-2923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-355-8494
-----------------------------------------------------
Fax | 860-354-9468
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 OLD PARK LANE RD SUITE 3
-----------------------------------------------------
City | NEW MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06776-2923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-355-8494
-----------------------------------------------------
Fax | 860-354-9468
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | DR. NESTOR MEJIAS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 860-355-8494
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 001495
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------