Provider Demographics
NPI:1982771978
Name:FAMILY PRACTICE OF CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:FAMILY PRACTICE OF CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-472-4220
Mailing Address - Street 1:112 MAYOR THOMAS J MCGRATH HWY
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4607
Mailing Address - Country:US
Mailing Address - Phone:671-472-4220
Mailing Address - Fax:617-472-2598
Practice Address - Street 1:112 MAYOR THOMAS J MCGRATH HWY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4607
Practice Address - Country:US
Practice Address - Phone:671-472-4220
Practice Address - Fax:617-472-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADC1915174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA760406OtherTUFTS HEALTH PLAN
MA352418OtherHARVARD PILGRIM
MAY36387OtherBCBS
MA=========OtherCIGNA
MA=========OtherAETNA
MAY36387OtherBCBS