Provider Demographics
NPI:1669626099
Name:NORTH SHORE SPINE & REHAB
Entity Type:Organization
Organization Name:NORTH SHORE SPINE & REHAB
Other - Org Name:WOBURN FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:PENDOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-938-9400
Mailing Address - Street 1:20 CUMMINGS PARK
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-2122
Mailing Address - Country:US
Mailing Address - Phone:781-938-9400
Mailing Address - Fax:781-938-9323
Practice Address - Street 1:20 CUMMINGS PARK
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-2122
Practice Address - Country:US
Practice Address - Phone:781-938-9400
Practice Address - Fax:781-938-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2611483OtherAETNA
MAY39891OtherBCBS
MA1697021OtherMASSHEALTH
MAAA7544OtherHPHC
MA460083OtherTUFTS
MAY36576OtherBCBS
MATAX IDOtherCIGNA
MA2611483OtherAETNA
MAAA7544OtherHPHC