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General NPI Number Information
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NPI Number | 1346577277
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Entity Type | Organization
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Legal Business Name | ADVANCED PHYSICAL HEALTH CENTER PC
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Dates
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Enumeration Date | 11/13/2009
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Last Update Date | 03/13/2023
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Provider Practice Location Address
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Address Line | 35 CHURCH ST
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City | CANAAN
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State | CT
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Zip | 06018-2466
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Country | US
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Telephone | 860-824-0748
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Fax | 860-824-0749
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Provider Business Mailing Address
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Address Line | 35 CHURCH ST
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City | CANAAN
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State | CT
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Zip | 06018-2466
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Country | US
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Telephone | 860-824-0748
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Fax | 860-824-0749
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Authorized Official
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Title or Position | DIRECTOR
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Name | MONICA SANDY NOWAK
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Credential | DC
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Telephone | 860-824-0748
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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 | 38MC00629800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 001818
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License Number State | CT
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