Provider Demographics
NPI:1295841575
Name:DOUGLAS FAMILY CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:DOUGLAS FAMILY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-888-3949
Mailing Address - Street 1:180 STATE RD
Mailing Address - Street 2:SUITE 2L
Mailing Address - City:SAGAMORE BEACH
Mailing Address - State:MA
Mailing Address - Zip Code:02562-2362
Mailing Address - Country:US
Mailing Address - Phone:508-888-3949
Mailing Address - Fax:508-888-3910
Practice Address - Street 1:180 STATE RD
Practice Address - Street 2:SUITE 2L
Practice Address - City:SAGAMORE BEACH
Practice Address - State:MA
Practice Address - Zip Code:02562-2362
Practice Address - Country:US
Practice Address - Phone:508-888-3949
Practice Address - Fax:508-888-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY49239Medicare UPIN