Provider Demographics
NPI:1962520296
Name:DZIURA CHIROPRACTIC PC
Entity type:Organization
Organization Name:DZIURA CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:DZIURA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-481-6150
Mailing Address - Street 1:650 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3613
Mailing Address - Country:US
Mailing Address - Phone:203-481-6150
Mailing Address - Fax:203-481-0411
Practice Address - Street 1:650 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3613
Practice Address - Country:US
Practice Address - Phone:203-481-6150
Practice Address - Fax:203-481-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0461111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT22992Medicare UPIN