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General NPI Number Information
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NPI Number | 1073265294
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Entity Type | Organization
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Legal Business Name | DTDC LLC
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 102 HOPMEADOW ST
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City | WEATOGUE
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State | CT
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Zip | 06089-9602
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Country | US
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Telephone | 860-651-3521
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Fax |
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Provider Business Mailing Address
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Address Line | 102 HOPMEADOW ST
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City | WEATOGUE
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State | CT
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Zip | 06089-9602
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Country | US
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Telephone | 860-651-3521
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Fax |
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DAVID TOLK
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Credential | DC
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Telephone | 860-651-3521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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