Provider Demographics
NPI:1821477308
Name:DERRY JOINT & SPINE CENTER PC
Entity Type:Organization
Organization Name:DERRY JOINT & SPINE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:603-434-1177
Mailing Address - Street 1:16 MANNING ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2388
Mailing Address - Country:US
Mailing Address - Phone:603-434-1177
Mailing Address - Fax:
Practice Address - Street 1:16 MANNING ST
Practice Address - Street 2:SUITE 107
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2388
Practice Address - Country:US
Practice Address - Phone:603-434-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty