Provider Demographics
NPI:1972900553
Name:ULTRACARE, P.C.
Entity Type:Organization
Organization Name:ULTRACARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:VIVEIROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-675-2840
Mailing Address - Street 1:PO BOX 4137
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02303-4137
Mailing Address - Country:US
Mailing Address - Phone:508-510-5221
Mailing Address - Fax:508-510-5126
Practice Address - Street 1:157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4012
Practice Address - Country:US
Practice Address - Phone:508-510-4221
Practice Address - Fax:508-510-5126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1013960152OtherMARCI SERONICK, D.C. INDIVIDUAL NPI
MA1184673956OtherJOHN A. MARSHALL, D.C. INDIVIDUAL NPI
MA1629214002OtherALLISON HURLEY, D.C. INDIVIDUAL NPI