1770846578 NPI number — ACCESS TO HEALTH CHIROPRACTIC LLC

Table of content: (NPI 1770846578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770846578 NPI number — ACCESS TO HEALTH CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCESS TO HEALTH CHIROPRACTIC LLC
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:
1770846578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 W BOYLSTON ST
Provider Second Line Business Mailing Address:
SUITE LL06
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01605-1265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-853-5333
Provider Business Mailing Address Fax Number:
508-853-5233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 W BOYLSTON ST
Provider Second Line Business Practice Location Address:
SUITE LL06
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01605-1265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-853-5333
Provider Business Practice Location Address Fax Number:
508-853-5233
Provider Enumeration Date:
06/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VARGAS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
508-963-5121

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3250 , 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: 1336474089 . This is a "NPI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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