Provider Demographics
NPI:1275704942
Name:SHORELINE CHIROPRACTIC CENTER, PLLC
Entity Type:Organization
Organization Name:SHORELINE CHIROPRACTIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:BAILEY
Authorized Official - Last Name:SANDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-285-5511
Mailing Address - Street 1:10 WINGATE ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-1132
Mailing Address - Country:US
Mailing Address - Phone:603-285-5511
Mailing Address - Fax:
Practice Address - Street 1:105 LAFAYETTE ROAD
Practice Address - Street 2:B-3
Practice Address - City:HAMPTON FALLS
Practice Address - State:NH
Practice Address - Zip Code:03842-2322
Practice Address - Country:US
Practice Address - Phone:603-285-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7200504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty