Provider Demographics
NPI:1619381613
Name:CENTER FOR CHIROPRACTIC CARE
Entity Type:Organization
Organization Name:CENTER FOR CHIROPRACTIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN-CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOIODICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:413-329-9420
Mailing Address - Street 1:510 NORTH ST
Mailing Address - Street 2:STE 4
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5493
Mailing Address - Country:US
Mailing Address - Phone:413-329-9420
Mailing Address - Fax:
Practice Address - Street 1:510 NORTH ST
Practice Address - Street 2:STE 4
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5493
Practice Address - Country:US
Practice Address - Phone:413-329-9420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S100152031Medicare PIN