Provider Demographics
NPI:1083730386
Name:CHIROPRACTIC HEALTH AND PERFORMANCE CENTER, PC
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH AND PERFORMANCE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-333-0323
Mailing Address - Street 1:535 WORCESTER RD
Mailing Address - Street 2:SUITE4
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-5364
Mailing Address - Country:US
Mailing Address - Phone:508-872-2555
Mailing Address - Fax:
Practice Address - Street 1:535 WORCESTER RD
Practice Address - Street 2:SUITE4
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5364
Practice Address - Country:US
Practice Address - Phone:508-872-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH2134111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45209Medicare ID - Type Unspecified