Provider Demographics
NPI:1528544624
Name:COMPASS CHIROPRACTIC SERVICES LLC
Entity Type:Organization
Organization Name:COMPASS CHIROPRACTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PROFESSIONAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-899-2413
Mailing Address - Street 1:481 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-7851
Mailing Address - Country:US
Mailing Address - Phone:781-605-2015
Mailing Address - Fax:781-605-3458
Practice Address - Street 1:481 FERRY ST
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-7851
Practice Address - Country:US
Practice Address - Phone:781-605-2015
Practice Address - Fax:781-605-3458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH385111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty