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General NPI Number Information
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NPI Number | 1083856462
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Entity Type | Organization
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Legal Business Name | VIVO CHIROPRACTIC WETHERSFIELD, LLC
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 465 SILAS DEANE HWY
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City | WETHERSFIELD
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State | CT
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Zip | 06109-2134
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Country | US
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Telephone | 860-257-8700
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Fax | 860-257-8720
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Provider Business Mailing Address
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Address Line | 465 SILAS DEANE HWY
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City | WETHERSFIELD
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State | CT
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Zip | 06109-2134
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Country | US
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Telephone | 860-257-8700
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Fax | 860-257-8720
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER LAVOIE
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Credential | D.C.
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Telephone | 860-257-8700
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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 | 1441
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License Number State | CT
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