Provider Demographics
NPI:1790936961
Name:DEGANGE CHIROPRACTIC
Entity Type:Organization
Organization Name:DEGANGE CHIROPRACTIC
Other - Org Name:BALANCE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTANA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DEGANGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-224-5551
Mailing Address - Street 1:14 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3772
Mailing Address - Country:US
Mailing Address - Phone:603-224-5551
Mailing Address - Fax:603-224-5552
Practice Address - Street 1:14 SOUTH ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3772
Practice Address - Country:US
Practice Address - Phone:603-224-5551
Practice Address - Fax:603-224-5552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7071103111N00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE7625Medicare PIN