Provider Demographics
NPI:1457661886
Name:NEW ENGLAND SPINE & DISC CENTER OF MASSACHUSETS
Entity Type:Organization
Organization Name:NEW ENGLAND SPINE & DISC CENTER OF MASSACHUSETS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-675-7774
Mailing Address - Street 1:279 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2320
Mailing Address - Country:US
Mailing Address - Phone:508-675-7774
Mailing Address - Fax:508-675-3077
Practice Address - Street 1:279 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2320
Practice Address - Country:US
Practice Address - Phone:508-675-7774
Practice Address - Fax:508-675-3077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2779111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty