Provider Demographics
NPI:1851440598
Name:BAYSTATE HEALTH SERVICES
Entity Type:Organization
Organization Name:BAYSTATE HEALTH SERVICES
Other - Org Name:CHELSEA CHIROPRACTIC OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-359-5200
Mailing Address - Street 1:5 N MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2317
Mailing Address - Country:US
Mailing Address - Phone:508-359-5200
Mailing Address - Fax:508-359-5256
Practice Address - Street 1:90 EVERTT AVE
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150
Practice Address - Country:US
Practice Address - Phone:617-887-2730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2145111N00000X
MA1926111NS0005X
MA1576111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Not Answered111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA685704OtherTUFTS PAYEE #
MAY40022OtherBLUE CROSS BLUE SHIELD
MAY40022OtherBLUE CROSS BLUE SHIELD