Individual provider Active NPI

Walter R Ialacci, DC

  • Chiropractor
  • Windsor, CT
National Provider Identifier
1811973365
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
000459 Issued in CT
Practice address
1060 Day Hill Rd
Windsor, CT 06095
Phone
(860) 688-6699
Fax
(860) 683-2113
NPI assigned
Dec 16, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 000459 CT Primary

Addresses

Primary practice location

1060 Day Hill Rd
Windsor, CT 06095

Mailing address

1080 Day Hill Rd Ste 105
Windsor, CT 06095-1781
Phone (860) 688-6699

Other identifiers 1

IdentifierTypeStateIssuer
004134467MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060111000376 CT Practitioner - Chiropractic 9739102245 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

88 Day Hill Rd
Suite 102
Windsor, CT 06095-2200
Phone (860) 688-6699

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
000459CTMDAudiologist
459CTMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Chiropractic Care of Windsor LLC Chiropractor CurrentSince Mar 1, 2006 Accepting new patients
Hartford Physician Services PC Past Accepting new patients

Locations

1080 Day Hill Rd
Ste 105
Windsor, CT 06095
Phone (860) 688-6699

88 Day Hill Rd
Ste 102
Windsor, CT 06095
Phone (860) 688-6699

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811973365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 DAY HILL RD STE 105",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060951781",
            "telephone_number": "860-688-6699",
            "fax_number": "860-683-2113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 DAY HILL RD",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "06095",
            "telephone_number": "860-688-6699",
            "fax_number": "860-683-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IALACCI",
        "first_name": "WALTER",
        "middle_name": "R",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CT",
            "license": "000459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004134467",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Windsor, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.