MEDICARE: CONNECTICUT BACK & WELLNESS CHIROPRACTIC 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	111N00000X	Chiropractor	001186	CT

General Provider Information

NPI Number	:	1679788517
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONNECTICUT BACK & WELLNESS CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	755 MAIN ST
Second Line	:
City	:	MONROE
State	:	CT
Zip	:	06468-2830
Country	:	US
Telephone Number	:	203-261-0064
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 MAIN ST
Second Line	:
City	:	MONROE
State	:	CT
Zip	:	06468-2830
Country	:	US
Telephone Number	:	203-261-0064
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. NICOLA VACCARO
Credential	:	DC
Telephone Number	:	203-261-0064

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/22/2020

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