Provider Demographics
NPI:1780798595
Name:NAULT CHIROPRACTIC PC
Entity type:Organization
Organization Name:NAULT CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:NAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-438-1444
Mailing Address - Street 1:33 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2752
Mailing Address - Country:US
Mailing Address - Phone:508-438-1444
Mailing Address - Fax:508-438-1445
Practice Address - Street 1:33 OAK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2752
Practice Address - Country:US
Practice Address - Phone:508-438-1444
Practice Address - Fax:508-438-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36839OtherBCBS IND
MAY39858OtherBCBS GRP
MAY45458Medicare ID - Type UnspecifiedIND
MAY39858OtherBCBS GRP
486130Medicare UPIN