Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 001664 | CT |
NPI | 1013001353 |
---|---|
Provider Name | Connie Seo |
First Address | Southport, CT 06890-1258 |
Second Address | Southport, CT 06890-1258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |