Provider Demographics
NPI:1730466467
Name:J DOLAK CHIROPRACTIC INC
Entity Type:Organization
Organization Name:J DOLAK CHIROPRACTIC INC
Other - Org Name:DOLAK FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOLAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-829-0300
Mailing Address - Street 1:768 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01520-1858
Mailing Address - Country:US
Mailing Address - Phone:508-829-0300
Mailing Address - Fax:508-829-0464
Practice Address - Street 1:768 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1858
Practice Address - Country:US
Practice Address - Phone:508-829-0300
Practice Address - Fax:508-829-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2902111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45731Medicare PIN