Provider Demographics
NPI:1972651370
Name:VIDEYKO CHIROPRACTIC
Entity Type:Organization
Organization Name:VIDEYKO CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR - OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDEYKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-465-1500
Mailing Address - Street 1:128 STATE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-6629
Mailing Address - Country:US
Mailing Address - Phone:978-465-1500
Mailing Address - Fax:978-465-7501
Practice Address - Street 1:128 STATE ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-6629
Practice Address - Country:US
Practice Address - Phone:978-465-1500
Practice Address - Fax:978-465-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA351205OtherHARVARD HEALTHCARE
515906OtherAETNA
MA711501OtherTUFTS
67990OtherCIGNA
MAY35447OtherBLUE CROSS BLUE SHIELD
MA351205OtherHARVARD HEALTHCARE