MEDICARE: CHIROPRACTIC FIRST

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050000806CT02	OTHER	CT	BC/BS
2	528408	OTHER	CT	AETNA
3	T00806	OTHER	CT	LANDMARK
4	ZS792	OTHER	CT	OXFORD

General Provider Information

NPI Number	:	1902090889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC FIRST

Provider Business Mailing Address
First Line	:	1 BRIDGEPORT AVE
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484-3211
Country	:	US
Telephone Number	:	203-922-1212
Fax Number	:	203-922-1202

Provider Business Practice Location Address
First Line	:	1 BRIDGEPORT AVE
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484-3211
Country	:	US
Telephone Number	:	203-922-1212
Fax Number	:	203-922-1202

Authorized Official
Title or Position	:	DR. LOGAN
Name	:	DR. GERALD J. LOGAN
Credential	:
Telephone Number	:	203-922-1212

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	06/14/2013

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Directions to “CHIROPRACTIC FIRST ” Practice Location

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