MEDICARE: PROFESSIONAL CHIROPRACTIC, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1053363994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL CHIROPRACTIC, INC

Provider Business Mailing Address
First Line	:	245 BLUE HILL AVE
Second Line	:
City	:	ROXBURY
State	:	MA
Zip	:	02119-2152
Country	:	US
Telephone Number	:	617-989-8881
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 BLUE HILL AVE
Second Line	:
City	:	ROXBURY
State	:	MA
Zip	:	02119-2152
Country	:	US
Telephone Number	:	617-989-8881
Fax Number	:	617-989-8810

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ADONIS MILANO
Credential	:
Telephone Number	:	617-989-8881

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/21/2022

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