Provider Demographics
NPI:1932379930
Name:BROADWAY CHIROPRACTIC OFFICE, PLLC
Entity Type:Organization
Organization Name:BROADWAY CHIROPRACTIC OFFICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:B
Authorized Official - Last Name:SZALOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-434-5151
Mailing Address - Street 1:72 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2322
Mailing Address - Country:US
Mailing Address - Phone:603-434-5151
Mailing Address - Fax:
Practice Address - Street 1:72 W BROADWAY
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2322
Practice Address - Country:US
Practice Address - Phone:603-434-5151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH758-0106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0005386Medicare PIN