Provider Demographics
NPI:1669589065
Name:MILTON CHIROPRACTIC AND REHABILITATION INC
Entity type:Organization
Organization Name:MILTON CHIROPRACTIC AND REHABILITATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDWER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PT
Authorized Official - Phone:617-471-4491
Mailing Address - Street 1:111 WILLARD ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1200
Mailing Address - Country:US
Mailing Address - Phone:617-471-4491
Mailing Address - Fax:
Practice Address - Street 1:111 WILLARD ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1200
Practice Address - Country:US
Practice Address - Phone:617-471-4491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT5835225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA735153OtherTUFTS HEALTH PLAN
MAY61012OtherBCBSMA
MAPT0259Medicare ID - Type Unspecified