Provider Demographics
NPI:1265566970
Name:BAYSIDE CHIROPRACTIC, PC
Entity type:Organization
Organization Name:BAYSIDE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:401-223-0111
Mailing Address - Street 1:11 SOUTH ANGELL STREET
Mailing Address - Street 2:# 327
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-223-0111
Mailing Address - Fax:401-490-9779
Practice Address - Street 1:73 TAUNTON AVE
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771
Practice Address - Country:US
Practice Address - Phone:401-223-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7823303OtherAETNA
RI408954OtherBLUE CHIP
352200OtherHARVARD PILGRIM
RI21228-7OtherBLUE CROSS BLUE SHIELD
7823303OtherAETNA
RI408954OtherBLUE CHIP