Provider Demographics
NPI:1326217837
Name:BOSTON SPORTS CHIROPRACTIC
Entity Type:Organization
Organization Name:BOSTON SPORTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-469-5899
Mailing Address - Street 1:8 BRADFORD GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-8281
Mailing Address - Country:US
Mailing Address - Phone:978-469-5899
Mailing Address - Fax:978-469-0773
Practice Address - Street 1:8 BRADFORD GREEN WAY
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-8281
Practice Address - Country:US
Practice Address - Phone:978-469-5899
Practice Address - Fax:978-469-0773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation