1821145731 NPI number — PERSONAL CARE CHIROPRACTIC & MASSAGE. P.C.

Table of content: (NPI 1821145731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821145731 NPI number — PERSONAL CARE CHIROPRACTIC & MASSAGE. P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERSONAL CARE CHIROPRACTIC & MASSAGE. P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821145731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 MASSACHUSETTS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02474-8623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-641-4482
Provider Business Mailing Address Fax Number:
781-641-4483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 MASSACHUSETTS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02474-8623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-641-4482
Provider Business Practice Location Address Fax Number:
781-641-4483
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STAMOULOS
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
781-641-4482

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1830 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 012624209 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2276060 . This is a "AETNA HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0024225 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1612948 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 695381 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 44-00106 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y30019 . This is a "HARVARDPILGRIM HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y39701 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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