Provider Demographics
NPI:1053456202
Name:ATTLEBORO CHIROPRACTIC HEALTH CENTER INC.
Entity Type:Organization
Organization Name:ATTLEBORO CHIROPRACTIC HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:GARTH
Authorized Official - Last Name:AUSSANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-431-2920
Mailing Address - Street 1:175 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2225
Mailing Address - Country:US
Mailing Address - Phone:508-431-2920
Mailing Address - Fax:508-431-2925
Practice Address - Street 1:175 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2225
Practice Address - Country:US
Practice Address - Phone:508-431-2920
Practice Address - Fax:508-431-2925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110074907AMedicaid
MA110095247AMedicaid