Provider Demographics
NPI:1275779787
Name:CORRECTIVE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:CORRECTIVE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ENGELHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-706-1667
Mailing Address - Street 1:157 CENTER BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01523-2227
Mailing Address - Country:US
Mailing Address - Phone:978-706-1667
Mailing Address - Fax:
Practice Address - Street 1:157 CENTER BRIDGE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:MA
Practice Address - Zip Code:01523-2227
Practice Address - Country:US
Practice Address - Phone:978-706-1667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA412111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0011163Medicare PIN