=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467466904
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CRAIG T SOLLOSE D.C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 246 FEDERAL RD C-35
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06804-2647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-740-2739
-----------------------------------------------------
Fax | 203-740-0124
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 246 FEDERAL RD C-35
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06804-2647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-740-2739
-----------------------------------------------------
Fax | 203-740-0124
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0001337
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------