Provider Demographics
NPI:1245337427
Name:ATLANTIC CHIROPRACTIC & REHAB., INC.
Entity type:Organization
Organization Name:ATLANTIC CHIROPRACTIC & REHAB., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:AUSSANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-369-6613
Mailing Address - Street 1:PO BOX 8458
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-0597
Mailing Address - Country:US
Mailing Address - Phone:401-490-2022
Mailing Address - Fax:401-490-2392
Practice Address - Street 1:303 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3845
Practice Address - Country:US
Practice Address - Phone:401-490-2022
Practice Address - Fax:401-490-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00521111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty