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General NPI Number Information
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NPI Number | 1083085518
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Entity Type | Organization
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Legal Business Name | ENERGETIC SPINE CHIROPRACTIC
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 10/09/2015
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Provider Practice Location Address
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Address Line | 1271 SOUTH BROAD ST. UNIT #11
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City | WALLINGFORD
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State | CT
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Zip | 06492
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Country | US
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Telephone | 301-247-3973
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Fax |
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Provider Business Mailing Address
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Address Line | 72 NEW CHESHIRE RD
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City | MERIDEN
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State | CT
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Zip | 06451-5072
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. SARAH ANDERSON
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Credential |
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Telephone | 301-247-3973
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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 | 001934
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License Number State | CT
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