Provider Demographics
NPI:1902107469
Name:STAMFORD CHIROPRACTIC & REHAB CENTER, LLC
Entity Type:Organization
Organization Name:STAMFORD CHIROPRACTIC & REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TWIT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-276-1293
Mailing Address - Street 1:999 SUMMER ST STE 204
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5513
Mailing Address - Country:US
Mailing Address - Phone:203-276-1293
Mailing Address - Fax:203-978-9079
Practice Address - Street 1:999 SUMMER ST STE 204
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5513
Practice Address - Country:US
Practice Address - Phone:203-276-1293
Practice Address - Fax:203-978-9079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001827305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service