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General NPI Number Information
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NPI Number | 1942348453
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CARE OF WINDSOR LLC
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 02/11/2021
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Provider Practice Location Address
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Address Line | 88 DAY HILL RD STE 102
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City | WINDSOR
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State | CT
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Zip | 06095-2200
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Country | US
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Telephone | 860-688-6699
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Fax | 860-683-2113
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Provider Business Mailing Address
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Address Line | 88 DAY HILL RD STE 102
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City | WINDSOR
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State | CT
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Zip | 06095-2200
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Country | US
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Telephone | 860-688-6699
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Fax | 860-683-2113
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Authorized Official
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Title or Position | OWNER
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Name | DR. WALTER R IALACCI
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Credential | D.C
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Telephone | 860-688-6699
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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 | 459
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License Number State | CT
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