Provider Demographics
NPI:1336370253
Name:NARDI FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:NARDI FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-677-6401
Mailing Address - Street 1:195 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3685
Mailing Address - Country:US
Mailing Address - Phone:860-677-6401
Mailing Address - Fax:860-677-6873
Practice Address - Street 1:195 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3685
Practice Address - Country:US
Practice Address - Phone:860-677-6401
Practice Address - Fax:860-677-6873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT165945860OtherINDIVIDUAL NPI
CT165945860OtherINDIVIDUAL NPI