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General NPI Number Information
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NPI Number | 1972713162
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Entity Type | Organization
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Legal Business Name | SPINE & PAIN REHABILITATION CENTER, P.C.
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 220 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06032-1949
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Country | US
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Telephone | 860-677-7246
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Fax | 860-677-1972
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Provider Business Mailing Address
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Address Line | 220 FARMINGTON AVE
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City | FARMINGTON
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State | CT
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Zip | 06032-1949
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Country | US
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Telephone | 860-677-7246
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Fax | 860-677-1972
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY F IERNA
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Credential | D.C.
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Telephone | 860-677-7246
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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 | 001383
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License Number State | CT
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