MEDICARE: BOULEVARD CHIROPRACTIC & WELLNESS CENTER

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
1	111N00000X	Chiropractor	001469	CT

General Provider Information

NPI Number	:	1750586806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOULEVARD CHIROPRACTIC & WELLNESS CENTER

Provider Business Mailing Address
First Line	:	1329 BOULEVARD
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1603
Country	:	US
Telephone Number	:	860-236-9300
Fax Number	:	860-236-9306

Provider Business Practice Location Address
First Line	:	1329 BOULEVARD
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1603
Country	:	US
Telephone Number	:	860-236-9300
Fax Number	:	860-236-9306

Authorized Official
Title or Position	:	CHIROPRACTIC PHYSICIAN
Name	:	DR. DANIEL WILLIAM SCARINGE
Credential	:	D.C.
Telephone Number	:	860-236-9300

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	12/21/2007

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