Provider Demographics
NPI:1740352897
Name:PREMIUM CARE CHIROPRACTIC CORP
Entity type:Organization
Organization Name:PREMIUM CARE CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:F
Authorized Official - Last Name:HIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-427-5514
Mailing Address - Street 1:793 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2446
Mailing Address - Country:US
Mailing Address - Phone:508-427-5514
Mailing Address - Fax:508-427-5587
Practice Address - Street 1:793 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-427-5514
Practice Address - Fax:508-427-5587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA311111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty