Provider Demographics
NPI:1134236656
Name:SPINAL THERAPY & CHIROPRACTIC SERVICES INC
Entity type:Organization
Organization Name:SPINAL THERAPY & CHIROPRACTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN
Authorized Official - Middle Name:WOO
Authorized Official - Last Name:SUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-289-7008
Mailing Address - Street 1:166 WINTHROP AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3915
Mailing Address - Country:US
Mailing Address - Phone:781-289-7008
Mailing Address - Fax:781-289-7242
Practice Address - Street 1:166 WINTHROP AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3915
Practice Address - Country:US
Practice Address - Phone:781-289-7008
Practice Address - Fax:781-289-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y39887OtherBCBS OF MA GROUP NO
Y45691Medicare ID - Type Unspecified