Healthcare Provider Details

I. General information

NPI: 1568469005
Provider Name (Legal Business Name): MICHAEL ETHAN CHARTOFF D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 BOYLSTON ST SUITE 41
BOSTON MA
02116-4613
US

IV. Provider business mailing address

162 BOYLSTON ST SUITE 41
BOSTON MA
02116-4613
US

V. Phone/Fax

Practice location:
  • Phone: 617-451-1111
  • Fax: 617-451-1122
Mailing address:
  • Phone: 617-451-1111
  • Fax: 617-451-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2236
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: