Provider Demographics
NPI:1124573126
Name:MASSACHUSETTS CHIROPRACTIC AND PERFORMANCE CENTER
Entity Type:Organization
Organization Name:MASSACHUSETTS CHIROPRACTIC AND PERFORMANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRACCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-413-0196
Mailing Address - Street 1:244 WALTON ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-5329
Mailing Address - Country:US
Mailing Address - Phone:508-320-9171
Mailing Address - Fax:
Practice Address - Street 1:244 WALTON ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-5329
Practice Address - Country:US
Practice Address - Phone:508-320-9171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty