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General NPI Number Information
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NPI Number | 1053733907
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Entity Type | Organization
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Legal Business Name | CANDLEWOOD CHIROPRACTIC CARE PC
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Dates
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Enumeration Date | 01/13/2014
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 247 FEDERAL RD
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City | BROOKFIELD
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State | CT
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Zip | 06804-2630
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Country | US
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Telephone | 203-775-5003
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Fax |
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Provider Business Mailing Address
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Address Line | 247 FEDERAL RD
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City | BROOKFIELD
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State | CT
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Zip | 06804-2630
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Country | US
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Telephone | 203-775-5003
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER ROUGHLEY
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Credential |
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Telephone | 203-775-5003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1284
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License Number State | CT
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