1720093594 NPI number — ONLINE ONTIME CHIROPRACTIC OF BOSTON, P.C.

Table of content: (NPI 1720093594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720093594 NPI number — ONLINE ONTIME CHIROPRACTIC OF BOSTON, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONLINE ONTIME CHIROPRACTIC OF BOSTON, 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:
COMMONWEALTH CHIROPRACTIC OF BOSTON
Provider Other Organization Name Type Code:
3
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:
1720093594
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
480 WASHINGTON ST STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIGHTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02135-2655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-739-0046
Provider Business Mailing Address Fax Number:
617-738-9441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
480 WASHINGTON ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-739-0046
Provider Business Practice Location Address Fax Number:
617-738-9441
Provider Enumeration Date:
07/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRABTREE
Authorized Official First Name:
TYLER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-739-0046

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1720093594 . This is a "ORGANIZATIONAL NPI" identifier . This identifiers is of the category "OTHER".