MEDICARE: ADVANCED SPINAL CARE OF MERIDEN LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1669185039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SPINAL CARE OF MERIDEN LLC

Provider Business Mailing Address
First Line	:	197 W MAIN ST
Second Line	:
City	:	MERIDEN
State	:	CT
Zip	:	06451-4024
Country	:	US
Telephone Number	:	203-237-6325
Fax Number	:	203-238-4757

Provider Business Practice Location Address
First Line	:	197 W MAIN ST
Second Line	:
City	:	MERIDEN
State	:	CT
Zip	:	06451-4024
Country	:	US
Telephone Number	:	203-237-6325
Fax Number	:	203-238-4757

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. RONALD MARINGOLA JR.
Credential	:	DC
Telephone Number	:	203-237-6325

Provider Enumeration Date	:	01/02/2023
Last Update Date	:	01/02/2023

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