Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 001879 | CT |
N | 111NR0400X | Rehabilitation Chiropractor | 001879 | CT |
NPI | 1154620037 |
---|---|
Provider Name | Dr. Tyler Curtis Page |
First Address | Mystic, CT 06355-1938 |
Second Address | Groton, CT 06340-2739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2011 |
Last Update Date | 15/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0100045708 | MEDICARE PTAN (01) | CT |