Provider Demographics
NPI:1568467181
Name:HENDERSON-RONCHETTI, AVA L (DC)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:L
Last Name:HENDERSON-RONCHETTI
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 1:24 PIERCE AVE
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2116
Mailing Address - Country:US
Mailing Address - Phone:603-216-1934
Mailing Address - Fax:
Practice Address - Street 1:159 CAMBRIDGE ST STE 2
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-1848
Practice Address - Country:US
Practice Address - Phone:617-782-5566
Practice Address - Fax:617-782-5757
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2219111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor