Provider Demographics
NPI:1811183775
Name:ATLANTIC CHIROPRACTIC INC.
Entity type:Organization
Organization Name:ATLANTIC CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BODZIOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MC
Authorized Official - Phone:781-438-9355
Mailing Address - Street 1:200D MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1619
Mailing Address - Country:US
Mailing Address - Phone:781-438-4278
Mailing Address - Fax:781-279-4834
Practice Address - Street 1:200D MAIN ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1619
Practice Address - Country:US
Practice Address - Phone:781-438-4278
Practice Address - Fax:781-279-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty