Provider Demographics
NPI:1154571024
Name:CENTRO QUIROPRACTICO HISPANO
Entity type:Organization
Organization Name:CENTRO QUIROPRACTICO HISPANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THEZLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ-ALPIZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-870-8962
Mailing Address - Street 1:1101 E MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06608-1653
Mailing Address - Country:US
Mailing Address - Phone:203-870-8962
Mailing Address - Fax:203-549-8960
Practice Address - Street 1:1101 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06608-1653
Practice Address - Country:US
Practice Address - Phone:203-870-8962
Practice Address - Fax:203-549-8960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty