NPIMap

Organization Active NPI

Advanced Back Center

  • Chiropractor
  • Southington, CT
National Provider Identifier
1043486947
Registry record updated May 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
000938 Issued in 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
Last updated
May 1, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stacey Kim Raya, D.C.NPI 1073502134
Title
Owner/President
Phone
(860) 621-2225

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 000938 CT Primary

Addresses

Primary practice location

200 Queen St
Southington, CT 06489-1901

Mailing address

200 Queen St
Southington, CT 06489-1901
Phone (860) 621-2225

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100727000265 CT Part B Supplier - Clinic/Group Practice 5395878433 Receives reassigned benefits from 8 practitioners
Practice locations: Southington, CT

National Provider Directory

National Provider Directory

Locations

200 Queen St
Southington, CT 06489
Phone (860) 621-2225

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1043486947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 QUEEN ST",
            "city": "SOUTHINGTON",
            "state": "CT",
            "postal_code": "064891901",
            "telephone_number": "860-621-2225",
            "fax_number": "860-621-2868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 QUEEN ST",
            "city": "SOUTHINGTON",
            "state": "CT",
            "postal_code": "064891901",
            "telephone_number": "860-621-2225",
            "fax_number": "860-621-2868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED BACK CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-01",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "RAYA",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "KIM",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "860-621-2225",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CT",
            "license": "000938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southington, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.