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General NPI Number Information
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NPI Number | 1700233921
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Entity Type | Organization
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Legal Business Name | CHS LIFE LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 05/17/2016
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 35 OLD TAVERN RD
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City | ORANGE
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State | CT
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Zip | 06477-3450
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Country | US
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Telephone | 203-693-3425
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1192
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City | ORANGE
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State | CT
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Zip | 06477-7192
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Country | US
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Telephone | 203-772-9224
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Fax |
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | MR. RICHARD A COVELLO
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Credential | L.AC.
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Telephone | 203-772-9224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 000212
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License Number State | CT
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