Provider Demographics
NPI:1851401442
Name:CANCRO CHIROPRACTIC PC
Entity Type:Organization
Organization Name:CANCRO CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCRO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-244-3330
Mailing Address - Street 1:18 STATION AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-2280
Mailing Address - Country:US
Mailing Address - Phone:617-244-3330
Mailing Address - Fax:617-244-3309
Practice Address - Street 1:18 STATION AVE
Practice Address - Street 2:UNIT A
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1222
Practice Address - Country:US
Practice Address - Phone:617-244-3330
Practice Address - Fax:617-244-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA792417OtherTUFTS
MAY36441OtherBCBS
2196431OtherCIGNA
350056OtherHPH
MAY36441OtherBCBS
350056OtherHPH