Basic Information
| Provider Information | |||||||||
| NPI: | 1841735859 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONNECTICUT NATURAL HEALTH SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 ROUTE 66 EAST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06237 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 315 EAST CENTER ST | ||||||||
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| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605330179 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2016 | ||||||||
| LastUpdateDate: | 12/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | YOUNG | ||||||||
| AuthorizedOfficialFirstName: | LAUREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8605330179 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CONNECTICUT NATURAL HEALTH SPECIALISTS | ||||||||
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| AuthorizedOfficialCredential: | ND | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 55300 | CT | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 175F00000X | 000397 | CT | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Naturopath |
No ID Information.