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

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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