Healthcare Provider Details

I. General information

NPI: 1851701619
Provider Name (Legal Business Name): BIG CITY CHIROPRACTIC & SPORTS INJURY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 03/28/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 DORCHESTER AVE
DORCHESTER MA
02124-2426
US

IV. Provider business mailing address

1855 DORCHESTER AVE
DORCHESTER MA
02124-2426
US

V. Phone/Fax

Practice location:
  • Phone: 617-533-8902
  • Fax: 617-533-7814
Mailing address:
  • Phone: 617-533-8902
  • Fax: 617-533-7814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number614
License Number StateMA

VIII. Authorized Official

Name: DR. BRIAN ELIAS
Title or Position: OWNER
Credential: D.C.
Phone: 617-533-8902