Provider Demographics
NPI:1013245356
Name:OCEAN STATE CHIROPRACTIC AND SPORTS REHABILITATION INC
Entity Type:Organization
Organization Name:OCEAN STATE CHIROPRACTIC AND SPORTS REHABILITATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:LEROUX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-354-5500
Mailing Address - Street 1:1920 MINERAL SPRING AVE UNIT 16
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3742
Mailing Address - Country:US
Mailing Address - Phone:401-354-5500
Mailing Address - Fax:401-354-7470
Practice Address - Street 1:1920 MINERAL SPRING AVE UNIT 16
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-3742
Practice Address - Country:US
Practice Address - Phone:401-354-5500
Practice Address - Fax:401-354-7470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty