Provider Demographics
NPI:1245837384
Name:CONNECTICUT BACK CENTER LLC
Entity type:Organization
Organization Name:CONNECTICUT BACK CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:EISLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-268-3349
Mailing Address - Street 1:460 HARTFORD TPKE STE B
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4847
Mailing Address - Country:US
Mailing Address - Phone:860-872-6229
Mailing Address - Fax:860-872-6252
Practice Address - Street 1:460 HARTFORD TPKE STE B
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4847
Practice Address - Country:US
Practice Address - Phone:860-872-6229
Practice Address - Fax:860-872-6252
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONNECTICUT BACK CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty