Provider Demographics
NPI:1427128776
Name:NAUGATUCK FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:NAUGATUCK FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ROCCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:203-723-7401
Mailing Address - Street 1:25 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4109
Mailing Address - Country:US
Mailing Address - Phone:203-723-7401
Mailing Address - Fax:203-723-9167
Practice Address - Street 1:25 CHERRY ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4109
Practice Address - Country:US
Practice Address - Phone:203-723-7401
Practice Address - Fax:203-723-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty