Provider Demographics
NPI:1053753335
Name:CHIROPRACTIC ASSOCIATES OF BRIDGEPORT, LLC
Entity type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES OF BRIDGEPORT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-374-4393
Mailing Address - Street 1:4444 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1820
Mailing Address - Country:US
Mailing Address - Phone:203-374-4393
Mailing Address - Fax:203-371-8584
Practice Address - Street 1:4444 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1820
Practice Address - Country:US
Practice Address - Phone:203-374-4393
Practice Address - Fax:203-371-8584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty