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
StateLicense IDTaxonomies
MA1330111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty