Provider Demographics
NPI:1740673771
Name:CENTER CITY CHIROPRACTIC, INC
Entity type:Organization
Organization Name:CENTER CITY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:CATER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-510-3081
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:508-510-3081
Mailing Address - Fax:508-510-5278
Practice Address - Street 1:793 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2446
Practice Address - Country:US
Practice Address - Phone:508-510-3081
Practice Address - Fax:508-510-5278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty