Provider Demographics
NPI:1659773026
Name:AB CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:AB CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AGATHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARRECA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-477-3978
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NH
Mailing Address - Zip Code:03773-0404
Mailing Address - Country:US
Mailing Address - Phone:603-477-3978
Mailing Address - Fax:
Practice Address - Street 1:6 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-1606
Practice Address - Country:US
Practice Address - Phone:603-477-3978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5290498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE4869Medicare PIN
NHU70641Medicare UPIN