Provider Demographics
NPI:1952480592
Name:ROBERT LAPUCK
Entity Type:Organization
Organization Name:ROBERT LAPUCK
Other - Org Name:BROCKTON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:LAPUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-588-3322
Mailing Address - Street 1:340 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-3236
Mailing Address - Country:US
Mailing Address - Phone:508-588-3322
Mailing Address - Fax:508-587-0411
Practice Address - Street 1:340 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-3236
Practice Address - Country:US
Practice Address - Phone:508-588-3322
Practice Address - Fax:508-587-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1604341Medicaid
MA1604341Medicaid