Provider Demographics
NPI:1336122332
Name:BRENTWOOD CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:BRENTWOOD CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:HERRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-679-5400
Mailing Address - Street 1:393 ROUTE 125
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03833-6611
Mailing Address - Country:US
Mailing Address - Phone:603-679-5400
Mailing Address - Fax:603-679-5400
Practice Address - Street 1:393 ROUTE 125
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NH
Practice Address - Zip Code:03833-6611
Practice Address - Country:US
Practice Address - Phone:603-679-5400
Practice Address - Fax:603-679-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH507-1197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty