Advanced Back Center
Organization Active NPI Chiropractor · Southington, CT
NPI 1043486947 · NPPES record last updated May 1, 2008
Key facts
- NPI
- 1043486947
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 000938 (CT)
- Legal business name
- ADVANCED BACK CENTER
- Practice address
- 200 Queen St
Southington, CT 06489-1901 - Phone
- (860) 621-2225
- Fax
- (860) 621-2868
- NPI assigned
- May 1, 2008
- Organization subpart
- No
Authorized official
- Name
- Stacey Kim Raya, D.C.
- Title
- Owner/President
- Phone
- (860) 621-2225
Practitioners 13
-
Jeana Forant, DC
-
Austin Lawrence, D.C.
-
Renee Ann Brown, D.C.
-
James Henry Davis, D.C.
-
Stacey Kim Raya, DC
-
Jason Thomas Stryjewski, D.C.
-
Francis J McNeary, D.C.
-
Adam Jay Ponchick, D.C.
-
Maegan Ranea Istok, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100727000265 | CT | Part B Supplier - Clinic/Group Practice | 5395878433 |
Receives reassigned benefits from 8 practitioners Practice locations: Southington, CT |
National Provider Directory
Locations
200 Queen St
Southington, CT 06489
Phone (860) 621-2225
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 000938 | CT | Yes |
Addresses
Primary practice location
200 Queen St
Southington, CT 06489-1901
Mailing address
200 Queen St
Southington, CT 06489-1901
Phone (860) 621-2225
Other providers in Southington, CT
- Jessica Isabel Abrantes-Figueiredo
- Absolute Home Care of CT
- Accu Vision Center, Inc
- Bridgitte F. Ackeifi
- Kasey Adinolfi
- Afc Physicians of Connecticut, PC
- Agape Homecare LLC
- Aguilar Salerno & Associates
- Nora Ainsworth
- Rachel N Albert
All providers in Southington, CT · Chiropractor in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.