Provider Demographics
NPI:1710194493
Name:WELLSPACE ASSOCIATES, P.C - CENTRAL SQUARE
Entity Type:Organization
Organization Name:WELLSPACE ASSOCIATES, P.C - CENTRAL SQUARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CHIROPRACTIC SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:KUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-876-2660
Mailing Address - Street 1:PO BOX 400985
Mailing Address - Street 2:WELLSPACE ASSOCIATES - CHIROPRACTIC DEPARTMENT
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-0010
Mailing Address - Country:US
Mailing Address - Phone:617-876-2660
Mailing Address - Fax:
Practice Address - Street 1:585 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4030
Practice Address - Country:US
Practice Address - Phone:617-547-0335
Practice Address - Fax:617-547-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty