Provider Demographics
NPI:1902011646
Name:PALLIS CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:PALLIS CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-255-7080
Mailing Address - Street 1:521 WALPOLE ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-1736
Mailing Address - Country:US
Mailing Address - Phone:781-255-7080
Mailing Address - Fax:
Practice Address - Street 1:521 WALPOLE ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-1736
Practice Address - Country:US
Practice Address - Phone:781-255-7080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY37086OtherBCBS OF MA
MAY37086OtherBCBS OF MA