Provider Demographics
NPI:1295195584
Name:MCGOVERN FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MCGOVERN FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-272-9746
Mailing Address - Street 1:47 ELM ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2835
Mailing Address - Country:US
Mailing Address - Phone:978-646-0010
Mailing Address - Fax:978-646-0076
Practice Address - Street 1:47 ELM ST STE 3
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2835
Practice Address - Country:US
Practice Address - Phone:978-646-0010
Practice Address - Fax:978-646-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3511111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty