Healthcare Provider Details

I. General information

NPI: 1780781989
Provider Name (Legal Business Name): RUGGIERO FAMILY CHIROPRACTIC & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 MAIN ST
MANCHESTER CT
06040-6013
US

IV. Provider business mailing address

1047 MAIN ST
MANCHESTER CT
06040-6013
US

V. Phone/Fax

Practice location:
  • Phone: 860-643-2888
  • Fax:
Mailing address:
  • Phone: 860-643-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1454
License Number StateCT

VIII. Authorized Official

Name: BRIAN STEPHEN RUGGIERO
Title or Position: OWNER
Credential: D.C.
Phone: 860-643-2888