=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114165487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAMATO CHIROPRACTIC CENTER, L L C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2009
-----------------------------------------------------
Last Update Date | 04/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 123 LOWREY PL
-----------------------------------------------------
City | NEWINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06111-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-436-2065
-----------------------------------------------------
Fax | 860-436-2066
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 123 LOWREY PL
-----------------------------------------------------
City | NEWINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06111-3003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-436-2065
-----------------------------------------------------
Fax | 860-436-2066
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHERYL DAMATO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-436-2065
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 001424
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------