Provider Demographics
NPI:1790821387
Name:ALDENVILLE CHIROPRACTIC
Entity Type:Organization
Organization Name:ALDENVILLE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:413-532-1040
Mailing Address - Street 1:755 GRATTAN ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1238
Mailing Address - Country:US
Mailing Address - Phone:413-532-1040
Mailing Address - Fax:413-536-0320
Practice Address - Street 1:755 GRATTAN ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1238
Practice Address - Country:US
Practice Address - Phone:413-532-1040
Practice Address - Fax:413-536-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA919111N00000X
MA1092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1605186Medicaid
MAY39578OtherMEDICARE MA GROUP NUMBER
MASA Y35635OtherBCBS MA CHARLES SAMSON
MASA Y35772OtherBCBS MA ANASTACIA SAMSON
MASA Y39578OtherBCBS MA GROUP NUMBER
MAY39578OtherMEDICARE MA GROUP NUMBER
MASA Y35635OtherBCBS MA CHARLES SAMSON