Provider Demographics
NPI:1821204009
Name:CHESTNUT HILL CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:CHESTNUT HILL CHIROPRACTIC, PC
Other - Org Name:CHESTNUT HILL CHIROPRACTIC & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GENSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-332-5105
Mailing Address - Street 1:180 WELLS AVE
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3328
Mailing Address - Country:US
Mailing Address - Phone:617-332-5105
Mailing Address - Fax:617-332-5108
Practice Address - Street 1:180 WELLS AVE
Practice Address - Street 2:SUITE 302A
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3328
Practice Address - Country:US
Practice Address - Phone:617-332-5105
Practice Address - Fax:617-332-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA528111N00000X
MA15084225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty