Provider Demographics
NPI:1063591899
Name:BOLOGNESE, EUGENE ANTHONY (DC)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:ANTHONY
Last Name:BOLOGNESE
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 1:769 HOPMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2206
Mailing Address - Country:US
Mailing Address - Phone:860-651-4385
Mailing Address - Fax:860-658-0492
Practice Address - Street 1:1 GRIST MILL RD
Practice Address - Street 2:
Practice Address - City:SIMSBURY
Practice Address - State:CT
Practice Address - Zip Code:06070
Practice Address - Country:US
Practice Address - Phone:860-651-4385
Practice Address - Fax:860-658-0492
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
01925271OtherUNITED HC
2170497OtherAETNA
0V6088OtherHEALTHNET
050001194CT01OtherBCBS
706158OtherCONNECTICARE
P2111736OtherOXFORD
4404312OtherUTC
706158OtherCONNECTICARE