1770658809 NPI number — CHIROPRACTIC HEALTH CENTER LLP

Table of content: (NPI 1770658809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770658809 NPI number — CHIROPRACTIC HEALTH CENTER LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC HEALTH CENTER 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:
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:
1770658809
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 PROVIDENCE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITINSVILLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01588-2125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-234-8222
Provider Business Mailing Address Fax Number:
508-234-7558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 PROVIDENCE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITINSVILLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01588-2125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-234-8222
Provider Business Practice Location Address Fax Number:
508-234-7558
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PENTLAND
Authorized Official First Name:
DEBBRA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
ACCOUNT MANAGER
Authorized Official Telephone Number:
508-234-8284

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  235 , 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: 35461 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 722474 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".




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