1205025285 NPI number — MERRIMACK VALLEY CHIROPRACTIC, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205025285 NPI number — MERRIMACK VALLEY CHIROPRACTIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERRIMACK VALLEY CHIROPRACTIC, INC
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:
1205025285
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1540 BRIDGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DRACUT
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01826-2611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-454-4300
Provider Business Mailing Address Fax Number:
978-454-8277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1540 BRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRACUT
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01826-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-454-4300
Provider Business Practice Location Address Fax Number:
978-454-8277
Provider Enumeration Date:
10/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GEARY
Authorized Official First Name:
LEAH
Authorized Official Middle Name:
PARENT
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
978-454-4300

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1901 , 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: 1610554 . This is a "MASSHEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0686337 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1831245208 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y39895 . This is a "BLUE CROSS BLUE SHIEL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 350014 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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