Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 432 | CT |
N | 111NS0005X | Chiropractic Sports Physician | 432 | CT |
NPI | 1063529634 |
---|---|
Provider Name | Dr. Ralph L Manfredi |
First Address | New Fairfield, CT 06812-5036 |
Second Address | New Fairfield, CT 06812-5036 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |