Provider Demographics
NPI:1740361419
Name:PELTON FAMILY CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:PELTON FAMILY CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-782-8380
Mailing Address - Street 1:730 KINGSTOWN RD STE 3
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3002
Mailing Address - Country:US
Mailing Address - Phone:401-782-8380
Mailing Address - Fax:401-782-3650
Practice Address - Street 1:730 KINGSTOWN RD STE 3
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3002
Practice Address - Country:US
Practice Address - Phone:401-782-8380
Practice Address - Fax:401-782-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDC332111N00000X
RIDC323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI44-00020OtherUHC -DR. CHRISTINE PELTON
RI44-00023OtherUHC -DR. KEVIN PELTON
RI9145-5OtherBLUE CROSS BLUE SHIELD RI
RI000323Medicaid
RI000332Medicaid
RI9145-5OtherBLUE CROSS BLUE SHIELD RI
RI000332Medicaid
RI=========OtherTRICARE