Provider Demographics
NPI:1760481345
Name:ERIC DIENER INC.
Entity Type:Organization
Organization Name:ERIC DIENER INC.
Other - Org Name:BAY STATE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DIENER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-337-7777
Mailing Address - Street 1:995 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-1928
Mailing Address - Country:US
Mailing Address - Phone:781-337-7777
Mailing Address - Fax:781-337-2803
Practice Address - Street 1:995 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-1928
Practice Address - Country:US
Practice Address - Phone:781-337-7777
Practice Address - Fax:781-337-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y39596OtherBCBS
Y39596OtherBCBS
Y45502Medicare ID - Type Unspecified