Provider Demographics
NPI:1164558144
Name:O'MALLEY FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:O'MALLEY FAMILY CHIROPRACTIC
Other - Org Name:CHIRO-SPA INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:O'MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-839-0040
Mailing Address - Street 1:80 WORCESTER ST
Mailing Address - Street 2:SUITE# 2
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1041
Mailing Address - Country:US
Mailing Address - Phone:508-839-0040
Mailing Address - Fax:508-839-0043
Practice Address - Street 1:80 WORCESTER ST
Practice Address - Street 2:SUITE# 2
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1041
Practice Address - Country:US
Practice Address - Phone:508-839-0040
Practice Address - Fax:508-839-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH 159-CF111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA699088OtherTUFTS HEALTH PLAN GROUP#
MAY39567OtherBCBS GROUP NUMBER
MA=========OtherTAX IDENTIFICATION NO.