Provider Demographics
NPI:1295309953
Name:CORE CHIROPRACTIC AND PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:CORE CHIROPRACTIC AND PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:CORNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-918-2185
Mailing Address - Street 1:969 MAIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1555
Mailing Address - Country:US
Mailing Address - Phone:508-918-2185
Mailing Address - Fax:508-974-4467
Practice Address - Street 1:969 MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1555
Practice Address - Country:US
Practice Address - Phone:508-918-2185
Practice Address - Fax:508-974-4467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty