Provider Demographics
NPI:1275696767
Name:B.R. CHIROPRACTIC MANAGEMENT, INC
Entity Type:Organization
Organization Name:B.R. CHIROPRACTIC MANAGEMENT, INC
Other - Org Name:SOFIA CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-687-7117
Mailing Address - Street 1:25 MARSTON ST STE 205
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2357
Mailing Address - Country:US
Mailing Address - Phone:978-687-7117
Mailing Address - Fax:978-687-7417
Practice Address - Street 1:25 MARSTON ST STE 205
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2357
Practice Address - Country:US
Practice Address - Phone:978-687-7117
Practice Address - Fax:978-687-7417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39388OtherBC & BS GROUP
MAY36382OtherBC & BS INDIVIDUAL
MA1610562Medicaid
MAY39388OtherBC & BS GROUP
MAY45016Medicare ID - Type Unspecified