Provider Demographics
NPI:1649440942
Name:SANTA, RAYMOND JR (DC)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:SANTA
Suffix:JR
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 1:1 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1722
Mailing Address - Country:US
Mailing Address - Phone:203-990-0190
Mailing Address - Fax:203-990-0191
Practice Address - Street 1:1 PARK AVE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1722
Practice Address - Country:US
Practice Address - Phone:203-990-0190
Practice Address - Fax:203-990-0191
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor