Provider Demographics
NPI:1558843482
Name:AXIS CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:AXIS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MILES
Authorized Official - Last Name:GLADSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-886-6150
Mailing Address - Street 1:630 PARK ST STE 301
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3659
Mailing Address - Country:US
Mailing Address - Phone:781-886-6150
Mailing Address - Fax:781-436-5986
Practice Address - Street 1:630 PARK ST STE 301
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3659
Practice Address - Country:US
Practice Address - Phone:781-886-6150
Practice Address - Fax:781-436-5986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty