Provider Demographics
NPI:1629374400
Name:RIDGEFIELD CHIROPRACTIC & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:RIDGEFIELD CHIROPRACTIC & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OF LLC- OWNER OF PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MASCETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-431-1688
Mailing Address - Street 1:10 SOUTH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4124
Mailing Address - Country:US
Mailing Address - Phone:203-431-1688
Mailing Address - Fax:203-431-1817
Practice Address - Street 1:10 SOUTH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4124
Practice Address - Country:US
Practice Address - Phone:203-431-1688
Practice Address - Fax:203-431-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty