Provider Demographics
NPI:1467599811
Name:THE PAIN RELIEF AND WELLNESS CENTER OF SOUTH HADLEY
Entity Type:Organization
Organization Name:THE PAIN RELIEF AND WELLNESS CENTER OF SOUTH HADLEY
Other - Org Name:DR. DEBORAH DEBASTIANI
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:DEBASTIANI
Authorized Official - Last Name:WHITTAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:413-532-1177
Mailing Address - Street 1:130 COLLEGE ST
Mailing Address - Street 2:SUITE 50
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-1493
Mailing Address - Country:US
Mailing Address - Phone:413-532-1177
Mailing Address - Fax:413-532-3466
Practice Address - Street 1:130 COLLEGE ST
Practice Address - Street 2:SUITE 50
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1493
Practice Address - Country:US
Practice Address - Phone:413-532-1177
Practice Address - Fax:413-532-3466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1770111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA439552OtherBLUE CROSS BLUE SHIELD
MA439552OtherBLUE CROSS BLUE SHIELD