| Mystic Spine & Sport Llc | |
|
12 Coogan Blvd Ste 204, Mystic, CT 06355-1938 | |
| (860) 245-4620 | |
| (860) 245-5752 |
| Full Name | Mystic Spine & Sport Llc |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 12 Coogan Blvd Ste 204, Mystic, Connecticut |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952692592 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | (* (Not Available)) | Primary |
| Provider Name | Tyler C Page |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1154620037 PECOS PAC ID: 8022294578 Enrollment ID: I20110518000003 |
| Provider Name | Chase William Livingston |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1003405887 PECOS PAC ID: 1850708025 Enrollment ID: I20210406001063 |
| Provider Name | Jay Matthew Nieuwenhuis |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1447027511 PECOS PAC ID: 2961847959 Enrollment ID: I20240229002103 |
| Mailing Address | Practice Location Address |
|---|---|
| Mystic Spine & Sport Llc 12 Coogan Blvd Ste 204, Mystic, CT 06355-1938 Ph: (860) 245-4620 | Mystic Spine & Sport Llc 12 Coogan Blvd Ste 204, Mystic, CT 06355-1938 Ph: (860) 245-4620 |
Dr. Tyler Curtis Page, D.C. Chiropractor Medicare: Accepting Medicare Assignments Practice Location: 12 Coogan Blvd Ste 204, Mystic, CT 06355 Phone: 860-245-4620 Fax: 860-245-5752 | |
New England Chiropractic, Llc Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 2 Greenmanville Ave, Suite B, Mystic, CT 06355 Phone: 860-536-6888 Fax: 860-536-6889 | |
Jay Matthew Nieuwenhuis, DC Chiropractor Medicare: Medicare Enrolled Practice Location: 12 Coogan Blvd Ste 202, Mystic, CT 06355 Phone: 860-245-4620 | |
Dr. Jennifer Louise Welch, D.C. Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 2 Greenmanville Ave, Suite B, Mystic, CT 06355 Phone: 860-536-6888 Fax: 860-536-6889 | |
Coastal Chiropractic & Family Wellness Centre Chiropractor Medicare: Not Enrolled in Medicare Practice Location: 23 Clara Dr, Suite 105, Mystic, CT 06355 Phone: 860-572-7711 |