Provider Demographics
NPI:1871552331
Name:SPINE & PAIN CENTERS OF CONNECTICUT PC
Entity type:Organization
Organization Name:SPINE & PAIN CENTERS OF CONNECTICUT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:IERNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-677-7246
Mailing Address - Street 1:270 FARMINGTON AVENUE
Mailing Address - Street 2:SUITE 152
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032
Mailing Address - Country:US
Mailing Address - Phone:860-677-7246
Mailing Address - Fax:860-677-1972
Practice Address - Street 1:270 FARMINGTON AVENUE
Practice Address - Street 2:SUITE 152
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-677-7246
Practice Address - Fax:860-677-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty