Provider Demographics
NPI: | 1659572659 |
---|---|
Name: | BOSTON SPINE CLINICS INC |
Entity Type: | Organization |
Organization Name: | BOSTON SPINE CLINICS INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | JOSEPH |
Authorized Official - Last Name: | HABERSTROH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC, DABCN, FACFE |
Authorized Official - Phone: | 617-666-1767 |
Mailing Address - Street 1: | PO BOX 45367 |
Mailing Address - Street 2: | |
Mailing Address - City: | SOMERVILLE |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02145 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 617-666-1767 |
Mailing Address - Fax: | 617-666-1747 |
Practice Address - Street 1: | 67 BROADWAY |
Practice Address - Street 2: | |
Practice Address - City: | SOMERVILLE |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02145 |
Practice Address - Country: | US |
Practice Address - Phone: | 617-666-1767 |
Practice Address - Fax: | 617-666-1747 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-29 |
Last Update Date: | 2016-02-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 1330 | 111NN0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111NN0400X | Chiropractic Providers | Chiropractor | Neurology | Group - Single Specialty |