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General NPI Number Information
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NPI Number | 1104929702
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Entity Type | Individual
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Provider Name | GARY R ITALIA DC
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 368 FRANKLIN AVE
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City | HARTFORD
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State | CT
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Zip | 06114
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Country | US
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Telephone | 860-296-4411
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Fax | 860-296-9995
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Provider Business Mailing Address
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Address Line | PO BOX 15
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City | ROCKY HILL
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State | CT
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Zip | 06067
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Country | US
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Telephone | 860-257-7448
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Fax | 860-257-9574
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 760
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 451
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 451
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License Number State | CT
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