Provider Demographics
NPI:1225138621
Name:MITCHELL S. TISHLER
Entity Type:Organization
Organization Name:MITCHELL S. TISHLER
Other - Org Name:CHATHAM CHIROPRACTIC WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:TISHLER
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:508-945-3131
Mailing Address - Street 1:60 MUNSON MEETING WAY
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02633
Mailing Address - Country:US
Mailing Address - Phone:508-945-3131
Mailing Address - Fax:
Practice Address - Street 1:60 MUNSON MEETING WAY
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:MA
Practice Address - Zip Code:02633
Practice Address - Country:US
Practice Address - Phone:508-945-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA797115OtherTUFTS HEALTH PLAN
MA35665OtherHARVARD PILGRIM
MAY35866OtherBLUE CROSS BLUE SHIELD
MAT58439Medicare UPIN
MA797115OtherTUFTS HEALTH PLAN