Provider Demographics
NPI:1134167521
Name:BROCKTON SPINE AND REHAB
Entity type:Organization
Organization Name:BROCKTON SPINE AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:GIAMPA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-250-0230
Mailing Address - Street 1:101 BRICK KILN RD
Mailing Address - Street 2:BLDG 1, UNIT 5
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3282
Mailing Address - Country:US
Mailing Address - Phone:978-250-0230
Mailing Address - Fax:978-250-8424
Practice Address - Street 1:80-86 MAIN STREET
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-1822
Practice Address - Country:US
Practice Address - Phone:508-828-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39606OtherBCBS
MAY39606OtherBCBS