Provider Demographics
NPI:1457405367
Name:CHIROPRACTIC HEALTH GROUP, PC
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DODES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-575-0100
Mailing Address - Street 1:95 WASHINGTON ST
Mailing Address - Street 2:SUITE 416
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-4006
Mailing Address - Country:US
Mailing Address - Phone:781-575-0100
Mailing Address - Fax:781-821-9964
Practice Address - Street 1:95 WASHINGTON ST
Practice Address - Street 2:SUITE 416
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-4006
Practice Address - Country:US
Practice Address - Phone:781-575-0100
Practice Address - Fax:781-821-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1871MA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA612569OtherTUFTS GROUP
MAY39167OtherBLUE CROSS GROUP