Provider Demographics
NPI:1851321665
Name:IN LINE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:IN LINE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACUMBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-347-3033
Mailing Address - Street 1:42 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1536
Mailing Address - Country:US
Mailing Address - Phone:508-347-9540
Mailing Address - Fax:
Practice Address - Street 1:113 MAIN ST
Practice Address - Street 2:UNITE #5
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1556
Practice Address - Country:US
Practice Address - Phone:508-347-3033
Practice Address - Fax:508-347-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY40070OtherBLU CROSS &BLUE SHIELD
MAAA76168OtherHARVARD PILGRIM
MA9752820Medicaid
MAAA76168OtherHARVARD PILGRIM