Provider Demographics
NPI:1154457869
Name:HOPE CHIROPRACTIC CENTRE, INC
Entity Type:Organization
Organization Name:HOPE CHIROPRACTIC CENTRE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BROCCOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-351-6390
Mailing Address - Street 1:635 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2652
Mailing Address - Country:US
Mailing Address - Phone:401-351-6390
Mailing Address - Fax:401-331-0614
Practice Address - Street 1:635 HOPE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2652
Practice Address - Country:US
Practice Address - Phone:401-351-6390
Practice Address - Fax:401-331-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9047-6OtherBLUE CROSS BLUE SHIELD RI
RI1689740607OtherINDIVIDUAL NPI NUMBER
RI1689740607OtherINDIVIDUAL NPI NUMBER