Provider Demographics
NPI:1538327614
Name:SPECIFIC CHIROPRACTIC HEALTH LLC
Entity type:Organization
Organization Name:SPECIFIC CHIROPRACTIC HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-316-8212
Mailing Address - Street 1:120 EAST AVE
Mailing Address - Street 2:SUITE 1WA
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851
Mailing Address - Country:US
Mailing Address - Phone:203-316-8212
Mailing Address - Fax:203-348-6595
Practice Address - Street 1:120 EAST AVE
Practice Address - Street 2:SUITE 1WA
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-316-8212
Practice Address - Fax:203-348-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty