=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396859922
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THEZLAY S. ALPIZAR D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2006
-----------------------------------------------------
Last Update Date | 11/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 419 WHALLEY AVE SUITE 313
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06511-3019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-848-1599
-----------------------------------------------------
Fax | 203-848-1603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 212 DODGE AVE
-----------------------------------------------------
City | EAST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06512-3338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-848-1599
-----------------------------------------------------
Fax | 203-848-1603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 001941
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------