Provider Demographics
NPI:1225105901
Name:ORIENT HEIGHTS CHIROPRACTIC OFFICE
Entity Type:Organization
Organization Name:ORIENT HEIGHTS CHIROPRACTIC OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-569-6607
Mailing Address - Street 1:1214 BENNINGTON ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1203
Mailing Address - Country:US
Mailing Address - Phone:617-569-6607
Mailing Address - Fax:617-569-8302
Practice Address - Street 1:1214 BENNINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1203
Practice Address - Country:US
Practice Address - Phone:617-569-6607
Practice Address - Fax:617-569-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35466OtherBCBS
MA1601776Medicaid
MA714763OtherTUFTS