Provider Demographics
NPI:1710299136
Name:AGAWAM CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:AGAWAM CHIROPRACTIC LLC
Other - Org Name:CAROLE LESSARD DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:LOGUE
Authorized Official - Last Name:LESSARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-496-7246
Mailing Address - Street 1:733 E MAIN ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-3977
Mailing Address - Country:US
Mailing Address - Phone:860-496-7246
Mailing Address - Fax:
Practice Address - Street 1:850 SPRINGFIELD ST
Practice Address - Street 2:C
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-2243
Practice Address - Country:US
Practice Address - Phone:860-496-7246
Practice Address - Fax:860-496-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1568568996OtherNPI