Healthcare Provider Details

I. General information

NPI: 1912321357
Provider Name (Legal Business Name): ROTH FAMILY CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 NEW BRITAIN RD
KENSINGTON CT
06037-1318
US

IV. Provider business mailing address

355 NEW BRITAIN RD
KENSINGTON CT
06037-1318
US

V. Phone/Fax

Practice location:
  • Phone: 860-829-0707
  • Fax: 860-829-0606
Mailing address:
  • Phone: 860-829-0707
  • Fax: 860-829-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number001773
License Number StateCT

VIII. Authorized Official

Name: DR. JUSTIN ROTH
Title or Position: OWNER
Credential: D.C.
Phone: 860-933-0038