Provider Demographics
NPI:1598104663
Name:MARSHFIELD CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MARSHFIELD CHIROPRACTIC LLC
Other - Org Name:DR. NICOLE MASTANDO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTANDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-834-7300
Mailing Address - Street 1:1020 PLAIN ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-2157
Mailing Address - Country:US
Mailing Address - Phone:781-834-7300
Mailing Address - Fax:781-834-7330
Practice Address - Street 1:1020 PLAIN ST
Practice Address - Street 2:SUITE 140
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-2157
Practice Address - Country:US
Practice Address - Phone:781-834-7300
Practice Address - Fax:781-834-7330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY37029OtherBLUECROSS BLUESHIELD
MAY45692Medicare UPIN