Provider Demographics
NPI:1225367717
Name:CAPE COD CHIROPRACTIC KINESIOLOGICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CAPE COD CHIROPRACTIC KINESIOLOGICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEAF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-746-6441
Mailing Address - Street 1:159 SAMOSET ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4815
Mailing Address - Country:US
Mailing Address - Phone:508-746-6441
Mailing Address - Fax:508-746-6569
Practice Address - Street 1:159 SAMOSET ST
Practice Address - Street 2:SUITE 4
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4815
Practice Address - Country:US
Practice Address - Phone:508-746-6441
Practice Address - Fax:508-746-6569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA340111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39975OtherBLUECROSS BLUE SHIELD OF MA
MA35375OtherHARVARD PILGRIM HEALTH CARE
MAY35039Medicare PIN