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General NPI Number Information
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NPI Number | 1275966640
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Entity Type | Organization
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Legal Business Name | RONCHETTI CHIROPRACTIC & WELLNESS CENTER, INC
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Dates
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Enumeration Date | 08/20/2013
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 1187 BLUE HILL AVE
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City | MATTAPAN
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State | MA
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Zip | 02126-1837
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Country | US
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Telephone | 617-298-4455
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Fax | 617-298-4450
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Provider Business Mailing Address
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Address Line | 1187 BLUE HILL AVE
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City | MATTAPAN
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State | MA
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Zip | 02126-1837
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Country | US
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Telephone | 617-298-4455
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Fax | 617-298-4450
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. AVA L HENDERSON-RONCHETTI
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Credential | D.C.
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Telephone | 617-298-4455
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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 | 2219
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License Number State | MA
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