Provider Demographics
NPI:1750392650
Name:FAMILY CHIROPRACTIC AND WELLNESS, LLC
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-288-0607
Mailing Address - Street 1:2337 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3504
Mailing Address - Country:US
Mailing Address - Phone:203-288-0607
Mailing Address - Fax:203-288-2650
Practice Address - Street 1:2337 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3504
Practice Address - Country:US
Practice Address - Phone:203-288-0607
Practice Address - Fax:203-288-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C03563Medicare ID - Type UnspecifiedGROUP IDENTIFIER