Provider Demographics
NPI:1700651049
Name:CAMBRIDGE CROSSING CHIROPRACTIC PC
Entity Type:Organization
Organization Name:CAMBRIDGE CROSSING CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SELWYN
Authorized Official - Middle Name:TYRONE
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-322-8179
Mailing Address - Street 1:14 MCGRATH HWY
Mailing Address - Street 2:EVERFITNESS GYM
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143
Mailing Address - Country:US
Mailing Address - Phone:508-322-8179
Mailing Address - Fax:
Practice Address - Street 1:14 MCGRATH HWY
Practice Address - Street 2:EVERFITNESS GYM
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143
Practice Address - Country:US
Practice Address - Phone:508-322-8179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty