Provider Demographics
NPI:1548329980
Name:CALATAYUD, JOHN PETER (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PETER
Last Name:CALATAYUD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 SCARD RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2722
Mailing Address - Country:US
Mailing Address - Phone:203-679-0546
Mailing Address - Fax:
Practice Address - Street 1:85 BARNES RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1832
Practice Address - Country:US
Practice Address - Phone:203-294-1700
Practice Address - Fax:203-294-1710
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT704111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350000463Medicare ID - Type Unspecified
CTT23327Medicare UPIN