Provider Demographics
NPI:1841313582
Name:MELROSE FAMILY CHIROPRACTIC & SPORTS INJURY CENTRE, INC
Entity type:Organization
Organization Name:MELROSE FAMILY CHIROPRACTIC & SPORTS INJURY CENTRE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SWENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-665-1497
Mailing Address - Street 1:653 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3101
Mailing Address - Country:US
Mailing Address - Phone:781-665-1497
Mailing Address - Fax:781-662-7111
Practice Address - Street 1:653 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3101
Practice Address - Country:US
Practice Address - Phone:781-665-1497
Practice Address - Fax:781-662-7111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39081OtherBLUE CROSS BLUE SHIELD
MA609766OtherTUFTS
MAY39081Medicare UPIN
MAY39081OtherBLUE CROSS BLUE SHIELD