Provider Demographics
NPI:1043320534
Name:DALFINO, STEPHEN ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ANTHONY
Last Name:DALFINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-2314
Mailing Address - Country:US
Mailing Address - Phone:860-296-6337
Mailing Address - Fax:860-296-1520
Practice Address - Street 1:740 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-2314
Practice Address - Country:US
Practice Address - Phone:860-296-6337
Practice Address - Fax:860-296-1520
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000839111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050000839CT05OtherBLUE CROSS BLUE SHIELD
CT050000839CT05OtherBLUE CROSS BLUE SHIELD