Provider Demographics
NPI:1326189366
Name:BRIDGEWOOD FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:BRIDGEWOOD FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDALLAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAALOUF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-937-5547
Mailing Address - Street 1:1794 BRIDGE ST
Mailing Address - Street 2:UNIT # 23
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-2673
Mailing Address - Country:US
Mailing Address - Phone:978-937-5547
Mailing Address - Fax:978-937-1155
Practice Address - Street 1:1794 BRIDGE ST
Practice Address - Street 2:UNIT # 23
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-2673
Practice Address - Country:US
Practice Address - Phone:978-937-5547
Practice Address - Fax:978-937-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39121Medicare PIN