Provider Demographics
NPI:1457463929
Name:CARUCCI, GINA MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:CARUCCI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Practice Address - Country:US
Practice Address - Phone:860-257-8445
Practice Address - Fax:860-257-8084
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT1130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT050001130CT02OtherBCBC
001130OtherCT CARE
CT050001130CT02OtherBCBC
U56570Medicare UPIN