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General NPI Number Information
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NPI Number | 1508030487
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Entity Type | Organization
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Legal Business Name | STAFFORD FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 72 WEST STAFFORD ROAD SUITE A-3
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076
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Country | US
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Telephone | 860-684-2227
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Fax | 860-684-6104
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Provider Business Mailing Address
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Address Line | P.O. BOX 110
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076
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Country | US
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Telephone | 860-684-2227
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Fax | 860-684-6104
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. GABRIEL JOHN THAYER
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Credential | D.C.
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Telephone | 860-684-2227
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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 |
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License Number State |
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