Provider Demographics
NPI:1902090889
Name:CHIROPRACTIC FIRST
Entity Type:Organization
Organization Name:CHIROPRACTIC FIRST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. LOGAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-922-1212
Mailing Address - Street 1:1 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-3211
Mailing Address - Country:US
Mailing Address - Phone:203-922-1212
Mailing Address - Fax:203-922-1202
Practice Address - Street 1:1 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-3211
Practice Address - Country:US
Practice Address - Phone:203-922-1212
Practice Address - Fax:203-922-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000806CT02OtherBC/BS
CT528408OtherAETNA
CTT00806OtherLANDMARK
CTZS792OtherOXFORD
CTT00806OtherLANDMARK