Provider Demographics
NPI:1427227594
Name:CAPE CHIROPRACTIC GROUP LLC
Entity Type:Organization
Organization Name:CAPE CHIROPRACTIC GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:AVITABILE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-778-5005
Mailing Address - Street 1:1665 FALMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-2944
Mailing Address - Country:US
Mailing Address - Phone:508-778-5005
Mailing Address - Fax:508-778-5006
Practice Address - Street 1:1665 FALMOUTH RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-2944
Practice Address - Country:US
Practice Address - Phone:508-778-5005
Practice Address - Fax:508-778-5006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110084899AMedicaid
MAY40145OtherBCBS MA
MA686094OtherTUFTS HEALTH PLAN