MEDICARE: NEW ERA CHIROPRACTIC LLC

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

General Provider Information

NPI Number	:	1790319481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW ERA CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	74 PARK RD
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1853
Country	:	US
Telephone Number	:	860-269-3228
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 RUSS ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-1520
Country	:	US
Telephone Number	:	860-269-3228
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	MATTHEW ROBERTS
Credential	:
Telephone Number	:	860-269-3228

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	06/02/2021

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Directions to “NEW ERA CHIROPRACTIC LLC ” Practice Location

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