Provider Demographics
NPI:1932549953
Name:DR BRIAN P CONNER LLC
Entity type:Organization
Organization Name:DR BRIAN P CONNER 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:PATRICK
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CNS, CDN
Authorized Official - Phone:203-775-1819
Mailing Address - Street 1:366 FEDERAL RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-2406
Mailing Address - Country:US
Mailing Address - Phone:203-775-1819
Mailing Address - Fax:203-775-2028
Practice Address - Street 1:366 FEDERAL RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2406
Practice Address - Country:US
Practice Address - Phone:203-775-1819
Practice Address - Fax:203-775-2028
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTHY WEIGHS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-05
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1485133N00000X
CT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty