1. Home
  2. Directory
  3. Connecticut
  4. Mystic
  5. Chiropractor
  6. NPI Profile

MYSTIC SPINE & SPORT LLC
NPI 1952692592
Chiropractor in Mystic, CT

Active since May 01, 2011
12 COOGAN BLVD STE 204, MYSTIC, CT 06355(860) 245-4620(860) 245-5752 Get Directions Write a Review

NPPES record last updated: February 2, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Mystic Spine & Sport Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MYSTIC SPINE & SPORT LLC (NPI 1952692592) is a healthcare organization registered as a chiropractor in Mystic, Connecticut and active in the NPI registry since May 2011. The organization lists Tyler Curtis Page, Owner/doctor, as its authorized official.

NPPES Registry Identity

NPI1952692592
Entity TypeOrganization
Primary Taxonomy111N00000X
Legal Business NameMYSTIC SPINE & SPORT LLC
Location Address12 COOGAN BLVD STE 204Mystic, CT 06355-1938
Mailing Address12 Coogan Blvd Ste 204Mystic, CT 06355-1938 · (860) 245-4620 · Fax (860) 245-5752
Phone(860) 245-4620
Fax(860) 245-5752
Organization SubpartNo
Authorized OfficialTyler Curtis PageOwner/doctor · (860) 245-4620
Enumeration DateMay 1, 2011
Last NPPES UpdateFebruary 2, 2024
NPPES CertifiedFebruary 2, 2024
✔ NPI 1952692592 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyChiropractorChiropractic Providers
Taxonomy Code111N00000X
Definition
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.
12 COOGAN BLVD STE 204, Mystic, CT 06355
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mystic Spine & Sport Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Mystic Spine & Sport LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Tyler Page, D.C.
Chiropractic
NPI 1154620037
12 COOGAN BLVD STE 204
Mystic, CT 06355
(860) 245-4620
✔ Accepts MedicareSame address
Chase Livingston, DC
Chiropractic
NPI 1003405887
159 BOSTON POST RD
East Lyme, CT 06333
(860) 374-2802
13 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mystic Spine & Sport LLC's NPI number?

The NPI number for Mystic Spine & Sport LLC is 1952692592. It was assigned to this organization in the NPPES registry on May 1, 2011.

Where is Mystic Spine & Sport LLC located?

Mystic Spine & Sport LLC is located at 12 Coogan Blvd Ste 204, Mystic, CT 06355. The listed phone number is (860) 245-4620.

What is Mystic Spine & Sport LLC's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Is Mystic Spine & Sport LLC enrolled in Medicare?

Yes. Mystic Spine & Sport LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mystic Spine & Sport LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Chiropractic, reassign their Medicare billing to Mystic Spine & Sport LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Mystic Spine & Sport LLC was last updated on February 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.