Provider Demographics
NPI:1447027511
Name:NIEUWENHUIS, JAY MATTHEW (DC)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:MATTHEW
Last Name:NIEUWENHUIS
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 1:12 COOGAN BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1938
Mailing Address - Country:US
Mailing Address - Phone:860-245-4620
Mailing Address - Fax:
Practice Address - Street 1:12 COOGAN BLVD STE 202
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1938
Practice Address - Country:US
Practice Address - Phone:860-245-4620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2304111N00000X
CT002304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor