Provider Demographics
NPI:1710138912
Name:GUDMUNDSSON CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:GUDMUNDSSON CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUDVIK
Authorized Official - Middle Name:
Authorized Official - Last Name:GUDMUNDSSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-675-3800
Mailing Address - Street 1:PO BOX 2727
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02722-2727
Mailing Address - Country:US
Mailing Address - Phone:508-675-3800
Mailing Address - Fax:508-675-4510
Practice Address - Street 1:400 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-2391
Practice Address - Country:US
Practice Address - Phone:508-675-3800
Practice Address - Fax:508-675-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA594111N00000X, 111NN0400X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty