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General NPI Number Information
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NPI Number | 1619683158
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Entity Type | Organization
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Legal Business Name | WHITECAP CHIROPRACTIC LLC
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Dates
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Enumeration Date | 01/27/2023
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 159 BOSTON POST RD
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City | EAST LYME
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State | CT
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Zip | 06333-1605
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Country | US
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Telephone | 860-884-4473
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Fax | 860-271-8115
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Provider Business Mailing Address
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Address Line | PO BOX 68
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City | EAST LYME
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State | CT
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Zip | 06333-0068
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Country | US
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Telephone | 860-884-4473
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Fax | 860-271-8115
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LEIGH SODERBERG
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Credential | DC
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Telephone | 860-884-4473
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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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