Provider Demographics
NPI:1447454244
Name:DOUGLAS CHIROPRACTIC CARE, LLP
Entity type:Organization
Organization Name:DOUGLAS CHIROPRACTIC CARE, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-667-2250
Mailing Address - Street 1:630 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-3783
Mailing Address - Country:US
Mailing Address - Phone:978-667-2250
Mailing Address - Fax:978-667-2290
Practice Address - Street 1:630 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-3783
Practice Address - Country:US
Practice Address - Phone:978-667-2250
Practice Address - Fax:978-667-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3108111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y40105OtherBLUE CROSS BLUE SHIELD OF MA
MA1605691Medicaid
8584951OtherCIGNA
MA1508973322OtherINDIVIDUAL NPI NUMBER
MA1605691Medicaid