Provider Demographics
NPI:1700105558
Name:SALEM CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:SALEM CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-744-1123
Mailing Address - Street 1:310 LAFAYETTE STREET
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5442
Mailing Address - Country:US
Mailing Address - Phone:978-744-1123
Mailing Address - Fax:978-744-9683
Practice Address - Street 1:310 LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5442
Practice Address - Country:US
Practice Address - Phone:978-744-1123
Practice Address - Fax:978-744-9683
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SALEM CHIROPRACTIC CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty