1689714180 NPI number — AERIE CHIROPRACTIC LTD PC

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 1689714180 NPI number — AERIE CHIROPRACTIC LTD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AERIE CHIROPRACTIC LTD PC
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:
1689714180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
433 TEATICKET HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEATICKET
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02536-6545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-548-7722
Provider Business Mailing Address Fax Number:
508-548-7722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
433 TEATICKET HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEATICKET
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02536-6545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-548-7722
Provider Business Practice Location Address Fax Number:
508-548-7722
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ESPERSON
Authorized Official First Name:
LISA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-548-7722

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  712 , 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: 35935 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AEY39047 . This is a "BCBS OF MASS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com