Provider Demographics
NPI:1083089908
Name:HEALTHSOURCE OF SHREWSBURY, INC
Entity Type:Organization
Organization Name:HEALTHSOURCE OF SHREWSBURY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MESSINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-842-4774
Mailing Address - Street 1:512 MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-6405
Mailing Address - Country:US
Mailing Address - Phone:508-842-4774
Mailing Address - Fax:508-842-5633
Practice Address - Street 1:512 MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-6405
Practice Address - Country:US
Practice Address - Phone:508-842-4774
Practice Address - Fax:508-842-5633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty