Provider Demographics
NPI:1770923252
Name:HYDE PARK CHIROPRACTIC CORP
Entity type:Organization
Organization Name:HYDE PARK CHIROPRACTIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SWIFT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-364-3300
Mailing Address - Street 1:891 HYDE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136
Mailing Address - Country:US
Mailing Address - Phone:617-364-3300
Mailing Address - Fax:617-364-3303
Practice Address - Street 1:891 HYDE PARK AVE
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3267
Practice Address - Country:US
Practice Address - Phone:617-364-3300
Practice Address - Fax:617-364-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2054111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty