Provider Demographics
NPI:1447206149
Name:ADVANCED BACK & NECK CENTER OF HOLYOKE
Entity Type:Organization
Organization Name:ADVANCED BACK & NECK CENTER OF HOLYOKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONAVITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-732-0088
Mailing Address - Street 1:155 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-2010
Mailing Address - Country:US
Mailing Address - Phone:413-732-0088
Mailing Address - Fax:413-737-9879
Practice Address - Street 1:172 HIGH ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6506
Practice Address - Country:US
Practice Address - Phone:413-538-7200
Practice Address - Fax:413-737-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39158OtherBCBS GROUP #
MA=========OtherTAX ID