Provider Demographics
NPI:1952422701
Name:BRIDGEWATER SQUARE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:BRIDGEWATER SQUARE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-697-0050
Mailing Address - Street 1:63 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-1455
Mailing Address - Country:US
Mailing Address - Phone:508-697-1831
Mailing Address - Fax:508-697-0882
Practice Address - Street 1:63 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-1455
Practice Address - Country:US
Practice Address - Phone:508-697-1831
Practice Address - Fax:508-697-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2182261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY40043OtherBCBS GROUP PROVIDER #
MA2990813OtherAETNA
MA351229OtherHARVARD PILGRIM
MA792311OtherTUFTS
MA2990813OtherAETNA
MA351229OtherHARVARD PILGRIM