Basic Information
| Provider Information | |||||||||
| NPI: | 1710191895 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHIROPRACTIC HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 S MAIN ST | ||||||||
| Address2: | PO BOX 5266 | ||||||||
| City: | BRADFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018357438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783747797 | ||||||||
| FaxNumber: | 9783749716 | ||||||||
| Practice Location | |||||||||
| Address1: | 147 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | BRADFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018357438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783747797 | ||||||||
| FaxNumber: | 9783749716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 02/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | MACKINNON | ||||||||
| AuthorizedOfficialFirstName: | LAURETTE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIROPRACTOR | ||||||||
| AuthorizedOfficialTelephone: | 9783747797 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 2116 | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.