Provider Demographics
NPI:1871710145
Name:OWENS CHIROPRACTIC PHYSICIANS, P.C.
Entity type:Organization
Organization Name:OWENS CHIROPRACTIC PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:EMMETT
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-232-3111
Mailing Address - Street 1:1112 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2163
Mailing Address - Country:US
Mailing Address - Phone:860-232-3111
Mailing Address - Fax:860-521-1683
Practice Address - Street 1:1112 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2163
Practice Address - Country:US
Practice Address - Phone:860-232-3111
Practice Address - Fax:860-521-1683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00067111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00908Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
CTT23366Medicare UPIN