Provider Demographics
NPI:1326514506
Name:SOUTH SHORE INTEGRATED HEALTH PC
Entity Type:Organization
Organization Name:SOUTH SHORE INTEGRATED HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RECUPERO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-829-6780
Mailing Address - Street 1:208 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2382
Mailing Address - Country:US
Mailing Address - Phone:781-829-6780
Mailing Address - Fax:781-829-6781
Practice Address - Street 1:208 BROADWAY
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-2382
Practice Address - Country:US
Practice Address - Phone:781-829-6780
Practice Address - Fax:781-829-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty