Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 001459 | CT |
NPI | 1003987801 |
---|---|
Provider Name | Dr. Adam R Church |
First Address | East Haven, CT 06512-3032 |
Second Address | East Haven, CT 06512-3032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
350001229 | (02) | CT |