Healthcare Provider Details

I. General information

NPI: 1639737604
Provider Name (Legal Business Name): CHIROPRACTIC SPORTS PERFORMANCE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 ROBINSON AVE
ATTLEBORO FALLS MA
02763-1100
US

IV. Provider business mailing address

51 ROBINSON AVE
ATTLEBORO FALLS MA
02763-1100
US

V. Phone/Fax

Practice location:
  • Phone: 508-316-8482
  • Fax:
Mailing address:
  • Phone: 508-316-8482
  • Fax: 508-804-7158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. MICCHAEL JEAN PEPIN
Title or Position: PRESIDENT/CEO
Credential: DC, CCSP, CSCS
Phone: 401-617-1001