Provider Demographics
NPI:1417360116
Name:CHIRO WELLNESS PROFESSIONALS LLC
Entity Type:Organization
Organization Name:CHIRO WELLNESS PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CUISLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIERANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-518-2799
Mailing Address - Street 1:1200 HANCOCK ST
Mailing Address - Street 2:STE 306
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4318
Mailing Address - Country:US
Mailing Address - Phone:617-405-4365
Mailing Address - Fax:
Practice Address - Street 1:1200 HANCOCK ST
Practice Address - Street 2:STE 306
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4318
Practice Address - Country:US
Practice Address - Phone:617-405-4365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3370111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0028725Medicare UPIN