Provider Demographics
NPI:1225270960
Name:DR.JOHN'S CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:DR.JOHN'S CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRUZZELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-627-9099
Mailing Address - Street 1:491 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2607
Mailing Address - Country:US
Mailing Address - Phone:617-627-9099
Mailing Address - Fax:617-627-9044
Practice Address - Street 1:491 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-2607
Practice Address - Country:US
Practice Address - Phone:617-627-9099
Practice Address - Fax:617-627-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty