Provider Demographics
NPI:1538339619
Name:WEST HARTFORD CHIROPRACTIC LLC
Entity type:Organization
Organization Name:WEST HARTFORD CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-232-5556
Mailing Address - Street 1:345 N MAIN ST STE 322
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2508
Mailing Address - Country:US
Mailing Address - Phone:860-232-5556
Mailing Address - Fax:860-232-5557
Practice Address - Street 1:345 N MAIN ST STE 322
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2508
Practice Address - Country:US
Practice Address - Phone:860-232-5556
Practice Address - Fax:860-232-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001568111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03290Medicare PIN