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General NPI Number Information
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NPI Number | 1750586806
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Entity Type | Organization
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Legal Business Name | BOULEVARD CHIROPRACTIC & WELLNESS CENTER
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 12/21/2007
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Provider Practice Location Address
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Address Line | 1329 BOULEVARD
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1603
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Country | US
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Telephone | 860-236-9300
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Fax | 860-236-9306
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Provider Business Mailing Address
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Address Line | 1329 BOULEVARD
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City | WEST HARTFORD
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State | CT
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Zip | 06119-1603
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Country | US
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Telephone | 860-236-9300
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Fax | 860-236-9306
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. DANIEL WILLIAM SCARINGE
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Credential | D.C.
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Telephone | 860-236-9300
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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 | 001469
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License Number State | CT
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