Provider Demographics
NPI:1609126390
Name:CHRISTIAN FANTINI, DC, LLC
Entity Type:Organization
Organization Name:CHRISTIAN FANTINI, DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FANTINI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-745-5454
Mailing Address - Street 1:20 CENTRAL ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3739
Mailing Address - Country:US
Mailing Address - Phone:978-745-5454
Mailing Address - Fax:978-745-5455
Practice Address - Street 1:20 CENTRAL ST
Practice Address - Street 2:SUITE 109
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3739
Practice Address - Country:US
Practice Address - Phone:978-745-5454
Practice Address - Fax:978-745-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA86640Medicare PIN
MAY35412Medicare UPIN