Provider Demographics
NPI:1790989853
Name:WELL ADJUSTED CHIROPRACTIC WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:WELL ADJUSTED CHIROPRACTIC WELLNESS CENTER, LLC
Other - Org Name:AGAWAM FAMILY CHIROPRACTIC LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:413-789-6664
Mailing Address - Street 1:430 MAIN STREET
Mailing Address - Street 2:SUITE 106
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001
Mailing Address - Country:US
Mailing Address - Phone:413-789-6664
Mailing Address - Fax:413-789-6694
Practice Address - Street 1:430 MAIN STREET
Practice Address - Street 2:SUITE 106
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001
Practice Address - Country:US
Practice Address - Phone:413-789-6664
Practice Address - Fax:413-789-6694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU84159Medicare UPIN
MAY49170Medicare ID - Type Unspecified