Individual
GARY R ITALIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
368 FRANKLIN AVE, HARTFORD, CT 06114
(860) 296-4411
(860) 296-9995
Mailing address
PO BOX 15, ROCKY HILL, CT 06067
(860) 257-7448
(860) 257-9574
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
760
CT
133N00000X
Nutritionist
451
CT
133V00000X
Registered Dietitian
451
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004089571
—
CT
Enumeration date
09/07/2006
Last updated
04/16/2013
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