Organization
BACK TO HEALTH OF BRANFORD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON L BAILEY (OFFICE ADMINISTRATOR)
(203) 483-7778
Entity
Organization
Contact information
Practice address
400 WEST MAIN STREET, BRANFORD, CT 06405
(203) 483-7778
(203) 481-0234
Mailing address
400 W MAIN ST, BRANFORD, CT 06405-3416
(203) 483-7778
(203) 481-0234
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
001614
CT
111N00000X
Chiropractor
148
CT
111NI0900X
Internist Chiropractor
000561
CT
207R00000X
Internal Medicine Physician
Primary
037255
CT
332B00000X
Durable Medical Equipment & Medical Supplies
037255
CT
335E00000X
Prosthetic/Orthotic Supplier
037255
CT
363LF0000X
Family Nurse Practitioner
002765
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008038901
—
CT
05
—
008038939
—
CT
01
—
07D1072612
CLIA WAIVER
CT
01
—
C02868
GROUP
—
Enumeration date
07/21/2006
Last updated
12/22/2014
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