Provider Demographics
NPI:1326249756
Name:MODERN FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MODERN FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:BENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-543-1866
Mailing Address - Street 1:17 COCASSET ST
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2948
Mailing Address - Country:US
Mailing Address - Phone:508-543-1866
Mailing Address - Fax:508-543-1867
Practice Address - Street 1:17 COCASSET ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-2948
Practice Address - Country:US
Practice Address - Phone:508-543-1866
Practice Address - Fax:508-543-1867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39626OtherBCBS MA GROUP ID # MFC
MAY39626OtherBCBS MA GROUP ID # MFC