Provider Demographics
NPI:1124602271
Name:DEVITA CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:DEVITA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVITA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-263-9336
Mailing Address - Street 1:179 GREAT RD STE 107
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5740
Mailing Address - Country:US
Mailing Address - Phone:978-263-9336
Mailing Address - Fax:978-264-4431
Practice Address - Street 1:179 GREAT RD STE 107
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5740
Practice Address - Country:US
Practice Address - Phone:978-263-9336
Practice Address - Fax:978-264-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty