Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 000772 | CT |
N | 111NR0400X | Rehabilitation Chiropractor | 000772 | CT |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 000772 | CT |
NPI | 1104950534 |
---|---|
Provider Name | Dr. Timothy Scott Pepin |
First Address | Wallingford, CT 06492-1737 |
Second Address | Wallingford, CT 06492-1737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |