Provider Demographics
NPI:1295892552
Name:HARBOR CHIROPRACTIC GROUP, LLC.
Entity type:Organization
Organization Name:HARBOR CHIROPRACTIC GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:KONSTANTINOS
Authorized Official - Last Name:PSICHOPAIDAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-999-4040
Mailing Address - Street 1:225 ROCKLAND STREET
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-3101
Mailing Address - Country:US
Mailing Address - Phone:508-999-4040
Mailing Address - Fax:508-993-9387
Practice Address - Street 1:225 ROCKLAND STREET
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3101
Practice Address - Country:US
Practice Address - Phone:508-999-4040
Practice Address - Fax:508-993-9387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH 2671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39716OtherBCBS MA - GROUP#