Provider Demographics
NPI:1952526691
Name:SYNAPTIC CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:SYNAPTIC CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEXICO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-939-8700
Mailing Address - Street 1:630 BALDWINVILLE RD.
Mailing Address - Street 2:
Mailing Address - City:BALDWINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01436
Mailing Address - Country:US
Mailing Address - Phone:978-939-8700
Mailing Address - Fax:978-939-8786
Practice Address - Street 1:630 BALDWINVILLE RD.
Practice Address - Street 2:
Practice Address - City:BALDWINVILLE
Practice Address - State:MA
Practice Address - Zip Code:01436
Practice Address - Country:US
Practice Address - Phone:978-939-8700
Practice Address - Fax:978-939-8786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY40116OtherBCBS OF MA
MA1477673689OtherCHIROPRACTOR
MA457312OtherTUFTS HEALTH PLAN
MAAA92111OtherHARVARD PILGRIM
MA0000245Medicare PIN
MAAA92111OtherHARVARD PILGRIM