Healthcare Provider Details

I. General information

NPI: 1184801797
Provider Name (Legal Business Name): HEBRON CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PENDLETON DR
HEBRON CT
06248-1525
US

IV. Provider business mailing address

10 PENDLETON DR PO BOX 56
HEBRON CT
06248-1525
US

V. Phone/Fax

Practice location:
  • Phone: 860-228-1441
  • Fax: 860-228-4475
Mailing address:
  • Phone: 860-228-1441
  • Fax: 860-228-4475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001695
License Number StateCT

VIII. Authorized Official

Name: DR. JUSTIN RONALD TREMBLAY
Title or Position: OWNER
Credential: DC
Phone: 860-228-1441