1841350253 NPI number — RAY OF LIGHT CHIROPRACTIC, PC

Table of content: (NPI 1841350253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841350253 NPI number — RAY OF LIGHT CHIROPRACTIC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAY OF LIGHT CHIROPRACTIC, 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:
1841350253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
239 BOSTON ST
Provider Second Line Business Mailing Address:
SUITE 212/214
Provider Business Mailing Address City Name:
TOPSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01983-2215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-887-9889
Provider Business Mailing Address Fax Number:
978-359-6023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
239 BOSTON ST
Provider Second Line Business Practice Location Address:
SUITE 212/214
Provider Business Practice Location Address City Name:
TOPSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01983-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-887-9889
Provider Business Practice Location Address Fax Number:
978-359-6023
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GODFREY
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
VIRGINIA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
978-887-9889

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH2330 , 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: 1902857394 . This is a "IND NPI #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y39382 . This is a "BC BS GROUP ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y6736 . This is a "BC BS INDV ID #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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