Healthcare Provider Details

I. General information

NPI: 1700105558
Provider Name (Legal Business Name): SALEM CHIROPRACTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 LAFAYETTE STREET
SALEM MA
01970-5442
US

IV. Provider business mailing address

310 LAFAYETTE STREET
SALEM MA
01970-5442
US

V. Phone/Fax

Practice location:
  • Phone: 978-744-1123
  • Fax: 978-744-9683
Mailing address:
  • Phone: 978-744-1123
  • Fax: 978-744-9683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. TROY D WILSON
Title or Position: OWNER
Credential: D.C.
Phone: 978-744-1123