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NPI Code Detail

MEDICARE: DR. STANLEY JOHN DEZJOT D.C.

MEDICARE: DR. STANLEY JOHN DEZJOT D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111NS0005XSports Physician Chiropractor1014CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669583423
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STANLEY JOHN DEZJOT D.C.
Provider Business Mailing Address
First Line : PO BOX 279
Second Line :
City : EAST LYME
State : CT
Zip : 06333-0279
Country : US
Telephone Number : 860-886-8007
Fax Number : 860-886-9545
Provider Business Practice Location Address
First Line : 108 NEW LONDON TPKE
Second Line :
City : NORWICH
State : CT
Zip : 06360-2645
Country : US
Telephone Number : 860-886-8007
Fax Number : 860-886-9545
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 07/09/2007

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