Provider Demographics
NPI:1275966640
Name:RONCHETTI CHIROPRACTIC & WELLNESS CENTER, INC
Entity Type:Organization
Organization Name:RONCHETTI CHIROPRACTIC & WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AVA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDERSON-RONCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-298-4455
Mailing Address - Street 1:1187 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-1837
Mailing Address - Country:US
Mailing Address - Phone:617-298-4455
Mailing Address - Fax:617-298-4450
Practice Address - Street 1:1187 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1837
Practice Address - Country:US
Practice Address - Phone:617-298-4455
Practice Address - Fax:617-298-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty