Provider Demographics
NPI:1851438097
Name:BREWERTON CHIROPRACTIC OFFICES
Entity Type:Organization
Organization Name:BREWERTON CHIROPRACTIC OFFICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:O
Authorized Official - Last Name:BREWERTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-534-6246
Mailing Address - Street 1:6 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3785
Mailing Address - Country:US
Mailing Address - Phone:978-534-6246
Mailing Address - Fax:978-534-6268
Practice Address - Street 1:6 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3785
Practice Address - Country:US
Practice Address - Phone:978-534-6246
Practice Address - Fax:978-534-6268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA729509OtherTUFTS
MAY39043OtherBLUECROSS BLUESHIELD