Healthcare Provider Details

I. General information

NPI: 1871067124
Provider Name (Legal Business Name): WICKED GOOD CHIROPRACTIC & WELLNESS GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WEST ST STE A
MANSFIELD MA
02048-2403
US

IV. Provider business mailing address

77 WEST ST STE A
MANSFIELD MA
02048-2403
US

V. Phone/Fax

Practice location:
  • Phone: 508-339-1418
  • Fax: 774-284-4927
Mailing address:
  • Phone: 508-339-1418
  • Fax: 774-287-9486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SARAH ANN CORCORAN
Title or Position: PRESIDENT
Credential: DC
Phone: 508-339-1418