Provider Demographics
NPI:1073957221
Name:SPA CHIROPRACTIC OF SALEM, LLC
Entity Type:Organization
Organization Name:SPA CHIROPRACTIC OF SALEM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRETT
Authorized Official - Last Name:SHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-498-4195
Mailing Address - Street 1:265 ESSEX ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3419
Mailing Address - Country:US
Mailing Address - Phone:978-498-4195
Mailing Address - Fax:978-594-8742
Practice Address - Street 1:265 ESSEX ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3419
Practice Address - Country:US
Practice Address - Phone:617-953-1036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty