Provider Demographics
NPI:1174867816
Name:A CHIROPRACTIC WELLNESS PLACE PC
Entity Type:Organization
Organization Name:A CHIROPRACTIC WELLNESS PLACE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CHIUNGOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-250-6886
Mailing Address - Street 1:5 FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-2708
Mailing Address - Country:US
Mailing Address - Phone:978-376-8190
Mailing Address - Fax:978-250-6887
Practice Address - Street 1:5 FLETCHER ST
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2708
Practice Address - Country:US
Practice Address - Phone:978-376-8190
Practice Address - Fax:978-250-6887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty