1851438097 NPI number — BREWERTON CHIROPRACTIC OFFICES

Table of content: (NPI 1851438097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851438097 NPI number — BREWERTON CHIROPRACTIC OFFICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREWERTON CHIROPRACTIC OFFICES
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:
1851438097
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEOMINSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01453-3785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-534-6246
Provider Business Mailing Address Fax Number:
978-534-6268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEOMINSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01453-3785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-534-6246
Provider Business Practice Location Address Fax Number:
978-534-6268
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BREWERTON
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
CHIROPRACTOR PARTNER
Authorized Official Telephone Number:
978-534-6246

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  212 , 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: 729509 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y39043 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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