Provider Demographics
NPI:1417051525
Name:BROADWAY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BROADWAY CHIROPRACTIC PC
Other - Org Name:BROADWAY FAMILY CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOWNES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-824-1700
Mailing Address - Street 1:290 BROADWAY
Mailing Address - Street 2:UNIT 2
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767
Mailing Address - Country:US
Mailing Address - Phone:508-824-1700
Mailing Address - Fax:508-824-6868
Practice Address - Street 1:290 BROADWAY
Practice Address - Street 2:UNIT 2
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767
Practice Address - Country:US
Practice Address - Phone:508-824-1700
Practice Address - Fax:508-824-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36158OtherBCBS OF MA
MAY39734OtherBCBS OF MA
MAY39734OtherBCBS OF MA