Organization
BACK TO MOTION SPORTS REHAB AND FITNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY ADAM VISCONTI D.C (CO-OWNER)
(860) 248-9989
Entity
Organization
Contact information
Practice address
435 WILLARD AVE, SUITE B, NEWINGTON, CT 06111-2318
(860) 665-0826
(860) 665-0826
Mailing address
435 WILLARD AVE, SUITE B, NEWINGTON, CT 06111-2318
(860) 665-0826
(860) 665-0826
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
2055
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679018600
SOLE PROPRIETOR NPI
CT
Enumeration date
02/14/2017
Last updated
02/14/2017
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