Provider Demographics
NPI:1124367313
Name:BAYSTATE FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BAYSTATE FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FILOMENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROCCA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-826-0053
Mailing Address - Street 1:346 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:W SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3915
Mailing Address - Country:US
Mailing Address - Phone:413-734-8100
Mailing Address - Fax:413-734-3437
Practice Address - Street 1:346 MAIN ST
Practice Address - Street 2:
Practice Address - City:W SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3915
Practice Address - Country:US
Practice Address - Phone:413-734-8100
Practice Address - Fax:413-734-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty