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General NPI Number Information
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NPI Number | 1184777666
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Entity Type | Organization
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Legal Business Name | SPINE AND SPORTS CHIROPRACTIC CARE OF CONNECTICUT, LLC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 10/20/2013
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Provider Practice Location Address
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Address Line | 220 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06032-1949
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Country | US
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Telephone | 860-269-3225
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Fax |
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Provider Business Mailing Address
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Address Line | 336 E HILL RD
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City | CANTON
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State | CT
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Zip | 06019-2119
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Country | US
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Telephone | 860-693-8567
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC HENRY VINCENT
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Credential | D.C.
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Telephone | 860-269-3225
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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 | 001504
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License Number State | CT
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