Healthcare Provider Details

I. General information

NPI: 1598984221
Provider Name (Legal Business Name): COMPLETE CARE CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 MAIN ST
ORLEANS MA
02653-2424
US

IV. Provider business mailing address

40 BLUE ROCK RD
SOUTH YARMOUTH MA
02664-1333
US

V. Phone/Fax

Practice location:
  • Phone: 508-240-7600
  • Fax:
Mailing address:
  • Phone: 508-240-7600
  • Fax: 508-240-7686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2879
License Number StateMA

VIII. Authorized Official

Name: DR. BENJAMIN THOMAS ANDRULOT
Title or Position: OWNER
Credential: D.C.
Phone: 508-240-7600