Provider Demographics
NPI:1710175518
Name:PEABODY FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:PEABODY FAMILY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:TIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CELESIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-905-2219
Mailing Address - Street 1:49 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4375
Mailing Address - Country:US
Mailing Address - Phone:978-531-0202
Mailing Address - Fax:978-532-7076
Practice Address - Street 1:49 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4375
Practice Address - Country:US
Practice Address - Phone:978-531-0202
Practice Address - Fax:978-532-7076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY40128OtherBCBSMA
MAY40128OtherBCBSMA