DTDC LLC
Organization Active NPI Chiropractor · Weatogue, CT
NPI 1073265294 · NPPES record last updated Jan 19, 2022
Key facts
- NPI
- 1073265294
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- Legal business name
- DTDC LLC
- Practice address
- 102 Hopmeadow St
Weatogue, CT 06089-9602 - Phone
- (860) 651-3521
- NPI assigned
- Jan 19, 2022
- Organization subpart
- No
Authorized official
- Name
- David Tolk, DC
- Title
- Sole Owner
- Phone
- (860) 651-3521
Practitioners 1
-
David Lloyd Tolk, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220203000212 | CT | Part B Supplier - Clinic/Group Practice | 3577956184 |
Receives reassigned benefits from 1 practitioner Practice locations: Avon, CT |
National Provider Directory
Locations
111 Simsbury Rd
Ste 1A
Avon, CT 06001
Phone (860) 325-2993
102 Hopmeadow St
Weatogue, CT 06089
Phone (860) 651-3521
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | Yes |
Addresses
Primary practice location
102 Hopmeadow St
Weatogue, CT 06089-9602
Mailing address
102 Hopmeadow St
Weatogue, CT 06089-9602
Phone (860) 651-3521
Other providers in Weatogue, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 19, 2022. 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.