Provider Demographics
NPI:1780920983
Name:CONNECTICUT CENTER FOR NATURAL HEALTH
Entity type:Organization
Organization Name:CONNECTICUT CENTER FOR NATURAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ND
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:860-347-8434
Mailing Address - Street 1:210 SOUTH MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-347-8600
Mailing Address - Fax:860-347-8434
Practice Address - Street 1:210 SOUTH MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-347-8600
Practice Address - Fax:860-347-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000259175F00000X
CT000060175F00000X
CT000171175F00000X
CT000145175F00000X
CT000241175F00000X
CT000061175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1124014683OtherNPI
CT1578559043OtherNPI
CT1639165103OtherNPI
CT1063408524OtherNPI
CT1386630788OtherNPI
CT1245226729OtherNPI
CT1063423937OtherNPI