Provider Demographics
NPI:1073704607
Name:BASS CHIROPRACTIC & PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BASS CHIROPRACTIC & PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BASSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAWLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:413-726-0912
Mailing Address - Street 1:1145 MAIN ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-2143
Mailing Address - Country:US
Mailing Address - Phone:413-726-0912
Mailing Address - Fax:413-686-9305
Practice Address - Street 1:1145 MAIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2143
Practice Address - Country:US
Practice Address - Phone:413-726-0912
Practice Address - Fax:413-686-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3120111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000827Medicare PIN