Provider Demographics
NPI:1326226119
Name:PORT CITY CHIROPRACTIC P.L.L.C.
Entity Type:Organization
Organization Name:PORT CITY CHIROPRACTIC P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-433-2447
Mailing Address - Street 1:10 VAUGHAN MALL STE 211
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4047
Mailing Address - Country:US
Mailing Address - Phone:603-433-2447
Mailing Address - Fax:603-433-6447
Practice Address - Street 1:10 VAUGHAN MALL
Practice Address - Street 2:SUITE 15
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4047
Practice Address - Country:US
Practice Address - Phone:603-433-2447
Practice Address - Fax:603-433-6447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH708-1103111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30253119Medicaid