Provider Demographics
NPI:1912789231
Name:VIVO CHIROPRACTIC GLASTONBURY LLC
Entity Type:Organization
Organization Name:VIVO CHIROPRACTIC GLASTONBURY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVOIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-257-8700
Mailing Address - Street 1:465 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-2134
Mailing Address - Country:US
Mailing Address - Phone:860-257-8700
Mailing Address - Fax:
Practice Address - Street 1:10 COMMERCE ST STE B
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4802
Practice Address - Country:US
Practice Address - Phone:860-430-9116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty