Provider Demographics
NPI:1629313903
Name:STURBRIDGE FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:STURBRIDGE FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-347-3834
Mailing Address - Street 1:PO BOX 659
Mailing Address - Street 2:
Mailing Address - City:FISKDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01518-0659
Mailing Address - Country:US
Mailing Address - Phone:508-347-3834
Mailing Address - Fax:
Practice Address - Street 1:464 MAIN ST
Practice Address - Street 2:
Practice Address - City:FISKDALE
Practice Address - State:MA
Practice Address - Zip Code:01518-1290
Practice Address - Country:US
Practice Address - Phone:508-347-3834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty