Provider Demographics
NPI:1316190309
Name:CHIROPRACTIC CARE CENTERS, INC
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE CENTERS, INC
Other - Org Name:ORTHOPEDIC CARE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSSELIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-557-9072
Mailing Address - Street 1:410 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-1367
Mailing Address - Country:US
Mailing Address - Phone:978-458-6620
Mailing Address - Fax:978-458-6671
Practice Address - Street 1:410 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1367
Practice Address - Country:US
Practice Address - Phone:978-458-6620
Practice Address - Fax:978-458-6671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM19661OtherBCBS
MAM19661OtherBCBS