Provider Demographics
NPI:1083811814
Name:NORTHEAST CHIROPRACTIC & SPORTS INJURY, INC
Entity Type:Organization
Organization Name:NORTHEAST CHIROPRACTIC & SPORTS INJURY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BARASSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-534-1222
Mailing Address - Street 1:81 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453
Mailing Address - Country:US
Mailing Address - Phone:978-534-1222
Mailing Address - Fax:978-534-2345
Practice Address - Street 1:81 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-534-1222
Practice Address - Fax:978-534-2345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH1621111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36130Medicare PIN