Provider Demographics
NPI:1922077502
Name:SPINAL THERAPY & REHABILITATION PC
Entity Type:Organization
Organization Name:SPINAL THERAPY & REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:DEMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-356-5525
Mailing Address - Street 1:77 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-1003
Mailing Address - Country:US
Mailing Address - Phone:978-356-5525
Mailing Address - Fax:978-356-5584
Practice Address - Street 1:77 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-1003
Practice Address - Country:US
Practice Address - Phone:978-356-5525
Practice Address - Fax:978-356-5584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4787572OtherCIGNA HEALTHCARE
Y39323OtherBLUE CROSS BLUE SHIELD
7943321OtherAETNA HEALTHCARE
Y36143Medicare UPIN
Y39323OtherBLUE CROSS BLUE SHIELD