Provider Demographics
NPI:1215302815
Name:CHIROPRACTIC & HEALTH ASSOCIATES, LLC
Entity type:Organization
Organization Name:CHIROPRACTIC & HEALTH ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER / CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-631-0555
Mailing Address - Street 1:404 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2231
Mailing Address - Country:US
Mailing Address - Phone:860-631-0555
Mailing Address - Fax:203-486-8237
Practice Address - Street 1:404 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2231
Practice Address - Country:US
Practice Address - Phone:860-631-0555
Practice Address - Fax:203-486-8237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1669400354OtherINDIVIDUAL NPI
CTV07013Medicare UPIN