Provider Demographics
NPI:1992861157
Name:DELISLE CHIROPRACTIC
Entity Type:Organization
Organization Name:DELISLE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:H
Authorized Official - Last Name:DELISLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-537-2490
Mailing Address - Street 1:14 MANNING AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5790
Mailing Address - Country:US
Mailing Address - Phone:978-537-2490
Mailing Address - Fax:978-534-8060
Practice Address - Street 1:14 MANNING AVE STE 303
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5790
Practice Address - Country:US
Practice Address - Phone:978-537-2490
Practice Address - Fax:978-534-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2019-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U81030Medicare UPIN
MAY45359Medicare ID - Type Unspecified