Provider Demographics
NPI:1013036326
Name:DECRESCENZO CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DECRESCENZO CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DECRESCENZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-435-2002
Mailing Address - Street 1:160 TAUNTON AVE.
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-4533
Mailing Address - Country:US
Mailing Address - Phone:401-435-2002
Mailing Address - Fax:401-435-3553
Practice Address - Street 1:160 TAUNTON AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-4533
Practice Address - Country:US
Practice Address - Phone:401-435-2002
Practice Address - Fax:401-435-3553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDC395111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007010542Medicare ID - Type Unspecified
RIU74421Medicare UPIN