Healthcare Provider Details

I. General information

NPI: 1700716222
Provider Name (Legal Business Name): ROGELIO GONZALEZ DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 LEWIS ST
HARTFORD CT
06103-2501
US

IV. Provider business mailing address

24 LEWIS ST
HARTFORD CT
06103-2501
US

V. Phone/Fax

Practice location:
  • Phone: 860-278-9141
  • Fax: 860-525-4013
Mailing address:
  • Phone: 860-278-9141
  • Fax: 860-525-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2394
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: