Provider Demographics
NPI:1073710596
Name:AQUENE HOLISTIC CHIROPRACTIC CENTER, INC
Entity Type:Organization
Organization Name:AQUENE HOLISTIC CHIROPRACTIC CENTER, INC
Other - Org Name:AQIDNECK ISLAND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:401-845-9283
Mailing Address - Street 1:333 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-7230
Mailing Address - Country:US
Mailing Address - Phone:401-845-9283
Mailing Address - Fax:
Practice Address - Street 1:333 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7230
Practice Address - Country:US
Practice Address - Phone:401-845-9283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9714511Medicaid
RICP 00408096OtherBC BLUE CHIP
RI0000023204-001OtherBCBS
RICP 00408096OtherBC BLUE CHIP