Provider Demographics
NPI:1235380460
Name:CHIROCARE ASSOCIATES, PC
Entity Type:Organization
Organization Name:CHIROCARE ASSOCIATES, PC
Other - Org Name:CHIROCARE - WILMINGTON
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:PURI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-488-3388
Mailing Address - Street 1:64G CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2179
Mailing Address - Country:US
Mailing Address - Phone:781-488-3388
Mailing Address - Fax:781-488-3363
Practice Address - Street 1:64G CONCORD ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-2179
Practice Address - Country:US
Practice Address - Phone:781-488-3388
Practice Address - Fax:781-488-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0005495OtherMEDICARE PTAN
MAY0005495Medicare UPIN