Provider Demographics
NPI:1407861057
Name:ACCIDENT PAIN CLINIC
Entity Type:Organization
Organization Name:ACCIDENT PAIN CLINIC
Other - Org Name:SOMERVILLE ORTHOPEDIC AND PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GIAMPA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-250-0230
Mailing Address - Street 1:101 BRICK KILN RD
Mailing Address - Street 2:BLDG 1, UNIT 5
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3282
Mailing Address - Country:US
Mailing Address - Phone:978-250-0230
Mailing Address - Fax:
Practice Address - Street 1:265 MEDFORD ST
Practice Address - Street 2:SUITE 604
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1963
Practice Address - Country:US
Practice Address - Phone:617-666-4433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39718OtherBCBS