Provider Demographics
NPI:1073627733
Name:CARUCCI CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:CARUCCI CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CARUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-257-8445
Mailing Address - Street 1:53 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1175
Mailing Address - Country:US
Mailing Address - Phone:860-257-8445
Mailing Address - Fax:860-257-8084
Practice Address - Street 1:53 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1175
Practice Address - Country:US
Practice Address - Phone:860-257-8445
Practice Address - Fax:860-257-8084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001130OtherCT CARE
CT050001130CT02OtherBC/BS
CT050001130CT02OtherBC/BS
CT350001110Medicare ID - Type Unspecified