Healthcare Provider Details

I. General information

NPI: 1578002366
Provider Name (Legal Business Name): BOSTON ORTHOPAEDIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 EVERETT AVE SUITE 1A
CHELSEA MA
02150-2385
US

IV. Provider business mailing address

111 EVERETT AVE SUITE 1A
CHELSEA MA
02150-2385
US

V. Phone/Fax

Practice location:
  • Phone: 781-235-3992
  • Fax: 781-235-3996
Mailing address:
  • Phone: 781-235-3992
  • Fax: 781-235-3996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM MULROY
Title or Position: DIRECTOR
Credential: M.D.
Phone: 781-235-3992