Provider Demographics
NPI:1124145701
Name:LABBADIA CARROCCIA CHIROPRACTIC OFFICES PC
Entity type:Organization
Organization Name:LABBADIA CARROCCIA CHIROPRACTIC OFFICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:LABBAIDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-632-1022
Mailing Address - Street 1:909 NEWFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-1817
Mailing Address - Country:US
Mailing Address - Phone:860-632-1022
Mailing Address - Fax:860-635-9501
Practice Address - Street 1:909 NEWFIELD ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1817
Practice Address - Country:US
Practice Address - Phone:860-632-1022
Practice Address - Fax:860-635-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty