Provider Demographics
NPI:1790907046
Name:CORDIMA CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:CORDIMA CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CORDIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-629-2600
Mailing Address - Street 1:168 SUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2824
Mailing Address - Country:US
Mailing Address - Phone:781-944-3290
Mailing Address - Fax:
Practice Address - Street 1:690 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2220
Practice Address - Country:US
Practice Address - Phone:617-629-2600
Practice Address - Fax:617-666-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2865499OtherAETNA GROUP#
MA687850OtherTUFTS GROUP#
MAY39639OtherBCBS GROUP#
MAY39639OtherBCBS GROUP#
MA=========OtherCIGNA GROUP#
MA=========OtherCIGNA GROUP#