Provider Demographics
NPI:1467613976
Name:BOSTON CHIROPRACTIC
Entity Type:Organization
Organization Name:BOSTON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRAHAM-TIPLER
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:617-250-8887
Mailing Address - Street 1:1537 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2103
Mailing Address - Country:US
Mailing Address - Phone:617-250-8887
Mailing Address - Fax:617-273-2393
Practice Address - Street 1:1537 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2103
Practice Address - Country:US
Practice Address - Phone:617-250-8887
Practice Address - Fax:617-273-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3188111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty