1952526691 NPI number — SYNAPTIC CHIROPRACTIC CENTER

Table of content: (NPI 1952526691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952526691 NPI number — SYNAPTIC CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYNAPTIC CHIROPRACTIC CENTER
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:
1952526691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 BALDWINVILLE RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALDWINVILLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-939-8700
Provider Business Mailing Address Fax Number:
978-939-8786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
630 BALDWINVILLE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALDWINVILLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-939-8700
Provider Business Practice Location Address Fax Number:
978-939-8786
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEXICO
Authorized Official First Name:
TODD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CLINIC DIRECTOR
Authorized Official Telephone Number:
978-939-8700

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3124 , 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: Y40116 . This is a "BCBS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1477673689 . This is a "CHIROPRACTOR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 457312 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA92111 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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