| Organization Name: | CARBONE CHIROPRACTIC CENTER DBA SOUTHSIDE PHYSICAL THERAPY LLC |
| NPI Number: | 1235558461 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GUY CARBONE (OWNER) |
| Mailing Address: | 82-86 Wolcott Hill Rd Suite 102 Wethersfield |
| State: | CT US |
| Postal Code: | 061091252 |
| Phone Number: | 8604363151 |
| Fax Number: | 8604363277 |
| NPI Enumeration Date: | 04/15/2014 |
| NPI Last Update Date: | 04/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 8123 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |