Provider Demographics
NPI:1053723940
Name:NORTH BRANFORD FAMILY CHIROPRACTIC AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:NORTH BRANFORD FAMILY CHIROPRACTIC AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:O'LOUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-208-0163
Mailing Address - Street 1:2429 FOXON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-4503
Mailing Address - Country:US
Mailing Address - Phone:203-208-0163
Mailing Address - Fax:203-208-1754
Practice Address - Street 1:2429 FOXON RD
Practice Address - Street 2:
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471-4503
Practice Address - Country:US
Practice Address - Phone:203-208-0163
Practice Address - Fax:203-208-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty