Provider Demographics
NPI:1932562238
Name:PREMIER CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:PREMIER CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHASSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-926-8899
Mailing Address - Street 1:198 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2241
Mailing Address - Country:US
Mailing Address - Phone:508-926-8899
Mailing Address - Fax:
Practice Address - Street 1:198 PARK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2241
Practice Address - Country:US
Practice Address - Phone:508-926-8899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty