Healthcare Provider Details

I. General information

NPI: 1134799141
Provider Name (Legal Business Name): CT JUNCTION CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 MERIDEN RD UNIT 2
WATERBURY CT
06705-1933
US

IV. Provider business mailing address

190 STONYBROOK LN
WATERTOWN CT
06795-1033
US

V. Phone/Fax

Practice location:
  • Phone: 203-490-9173
  • Fax:
Mailing address:
  • Phone: 203-490-9173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW ROCHA
Title or Position: OWNER
Credential: DC
Phone: 203-490-9173