1447454244 NPI number — DOUGLAS CHIROPRACTIC CARE, LLP

Table of content: (NPI 1447454244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447454244 NPI number — DOUGLAS CHIROPRACTIC CARE, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS CHIROPRACTIC CARE, LLP
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:
6
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:
1447454244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 BOSTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILLERICA
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01821-3783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-667-2250
Provider Business Mailing Address Fax Number:
978-667-2290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 BOSTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILLERICA
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01821-3783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-667-2250
Provider Business Practice Location Address Fax Number:
978-667-2290
Provider Enumeration Date:
06/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOUGLAS
Authorized Official First Name:
BETH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
978-667-2250

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3108 , 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: Y40105 . This is a "BLUE CROSS BLUE SHIELD OF MA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1605691 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8584951 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1508973322 . This is a "INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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