NPIMap

Organization Active NPI

Physical Medicine and Family Wellness Center, LLC

  • Chiropractor
  • Sandy Hook, CT
National Provider Identifier
1235156936
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
001672 Issued in CT
Legal business name
PHYSICAL MEDICINE AND FAMILY WELLNESS CENTER, LLC
Practice address
24 Glen Rd
Sandy Hook, CT 06482-1124
Phone
(203) 426-6334
Fax
(203) 426-3070
NPI assigned
Jul 17, 2006
Last updated
Nov 13, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Authorized official

Name
Dr. Rod Deraney, D.C.NPI 1750308441
Title
Owner/ Manager
Phone
(203) 426-6334

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 001672 CT Primary

Addresses

Primary practice location

24 Glen Rd
Sandy Hook, CT 06482-1124

Mailing address

24 Glen Rd
Sandy Hook, CT 06482-1124
Phone (203) 426-6334

National Provider Directory

National Provider Directory

Locations

75 Glen Rd
Ste 106
Sandy Hook, CT 06482
Phone (203) 426-6334

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1235156936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 GLEN RD",
            "city": "SANDY HOOK",
            "state": "CT",
            "postal_code": "064821124",
            "telephone_number": "203-426-6334",
            "fax_number": "203-426-3070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 GLEN RD",
            "city": "SANDY HOOK",
            "state": "CT",
            "postal_code": "064821124",
            "telephone_number": "203-426-6334",
            "fax_number": "203-426-3070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL MEDICINE AND FAMILY WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "DERANEY",
        "authorized_official_first_name": "ROD",
        "authorized_official_title_or_position": "OWNER/ MANAGER",
        "authorized_official_telephone_number": "203-426-6334",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "CT",
            "license": "001672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy Hook, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.