Provider Demographics
NPI:1790973709
Name:COMMUNITY CHIROPRACTIC OF GROTON INC.
Entity Type:Organization
Organization Name:COMMUNITY CHIROPRACTIC OF GROTON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:JARBOE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-448-9355
Mailing Address - Street 1:300 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1234
Mailing Address - Country:US
Mailing Address - Phone:978-448-9355
Mailing Address - Fax:978-448-9359
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1234
Practice Address - Country:US
Practice Address - Phone:978-448-9355
Practice Address - Fax:978-448-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45320Medicare PIN