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General NPI Number Information
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NPI Number | 1154752129
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CARE, LLC
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Dates
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Enumeration Date | 12/02/2013
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 1162 DIXWELL AVE SUITE A
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City | HAMDEN
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State | CT
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Zip | 06514-4732
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Country | US
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Telephone | 203-250-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 334 N BROOKSVALE RD
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City | CHESHIRE
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State | CT
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Zip | 06410-3339
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Country | US
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Telephone | 203-250-7246
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. THERESA ANN LEVINE
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Credential | DC
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Telephone | 203-250-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 001415
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License Number State | CT
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