MEDICARE: AVA L. HENDERSON-RONCHETTI D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2219	MA

General Provider Information

NPI Number	:	1568467181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVA L. HENDERSON-RONCHETTI D.C.

Provider Business Mailing Address
First Line	:	24 PIERCE AVE
Second Line	:
City	:	DERRY
State	:	NH
Zip	:	03038-2116
Country	:	US
Telephone Number	:	603-216-1934
Fax Number	:

Provider Business Practice Location Address
First Line	:	159 CAMBRIDGE ST STE 2
Second Line	:
City	:	ALLSTON
State	:	MA
Zip	:	02134-1848
Country	:	US
Telephone Number	:	617-782-5566
Fax Number	:	617-782-5757

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	08/09/2007

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