Provider Demographics
NPI:1982218103
Name:WESTERN MASS CHIROPRACTIC PC
Entity Type:Organization
Organization Name:WESTERN MASS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:NICARETTA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:413-264-0700
Mailing Address - Street 1:275 BICENTENNIAL HWY STE 211
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1965
Mailing Address - Country:US
Mailing Address - Phone:413-264-0700
Mailing Address - Fax:
Practice Address - Street 1:275 BICENTENNIAL HWY STE 211
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1965
Practice Address - Country:US
Practice Address - Phone:413-264-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty