Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 183 | CT |
NPI | 1013019231 |
---|---|
Provider Name | Dr. Craig Dee Oconnell |
First Address | Hamden, CT 06517-3432 |
Second Address | Hamden, CT 06517-3432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T22340 | (02) |