Provider Demographics
NPI:1104085125
Name:WESTSIDE CHIROPRACTIC OF TOLLAND, LLC
Entity type:Organization
Organization Name:WESTSIDE CHIROPRACTIC OF TOLLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-875-0029
Mailing Address - Street 1:68 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-2841
Mailing Address - Country:US
Mailing Address - Phone:860-871-0451
Mailing Address - Fax:860-875-3445
Practice Address - Street 1:68 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-2841
Practice Address - Country:US
Practice Address - Phone:860-871-0451
Practice Address - Fax:860-875-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty