Healthcare Provider Details

I. General information

NPI: 1568467181
Provider Name (Legal Business Name): AVA L. HENDERSON-RONCHETTI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 CAMBRIDGE ST STE 2
ALLSTON MA
02134-1848
US

IV. Provider business mailing address

24 PIERCE AVE
DERRY NH
03038-2116
US

V. Phone/Fax

Practice location:
  • Phone: 617-782-5566
  • Fax: 617-782-5757
Mailing address:
  • Phone: 603-216-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2219
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: