Provider Demographics
NPI:1457804726
Name:BEANTOWN CHIROPRACTIC CORP
Entity Type:Organization
Organization Name:BEANTOWN CHIROPRACTIC CORP
Other - Org Name:BEANTOWN CHIROPRACTIC & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-605-0126
Mailing Address - Street 1:775 EASTERN AVE
Mailing Address - Street 2:STE. 3
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-5910
Mailing Address - Country:US
Mailing Address - Phone:781-605-0126
Mailing Address - Fax:781-605-3494
Practice Address - Street 1:775 EASTERN AVE
Practice Address - Street 2:STE. 3
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-5910
Practice Address - Country:US
Practice Address - Phone:781-605-0126
Practice Address - Fax:781-605-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty