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General NPI Number Information
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NPI Number | 1629081690
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Entity Type | Organization
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Legal Business Name | CT SPINE AND DISC CENTER LLC
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 30 HEBRON AVE #C DERR PLAZA
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City | GLASTONBURY
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State | CT
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Zip | 06033-4211
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Country | US
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Telephone | 860-633-8756
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Fax | 860-633-8757
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Provider Business Mailing Address
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Address Line | 30 HEBRON AVE #C DERR PLAZA
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City | GLASTONBURY
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State | CT
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Zip | 06033-4211
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Country | US
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Telephone | 860-633-8756
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Fax | 860-633-8757
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Authorized Official
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Title or Position | MEMBER
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Name | DR. MATTHEW J BELLINGER
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Credential | DC
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Telephone | 860-633-8756
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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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