Provider Demographics
NPI:1942558598
Name:CAPE COD SPORTS CHIROPRACTIC
Entity Type:Organization
Organization Name:CAPE COD SPORTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:COUILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:774-228-2179
Mailing Address - Street 1:86 COTUIT RD
Mailing Address - Street 2:UNIT B1
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648-5716
Mailing Address - Country:US
Mailing Address - Phone:774-228-2179
Mailing Address - Fax:774-228-2178
Practice Address - Street 1:86 COTUIT RD
Practice Address - Street 2:UNIT B1
Practice Address - City:MARSTONS MILLS
Practice Address - State:MA
Practice Address - Zip Code:02648-5716
Practice Address - Country:US
Practice Address - Phone:774-228-2179
Practice Address - Fax:774-228-2178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty