Healthcare Provider Details

I. General information

NPI: 1851321665
Provider Name (Legal Business Name): IN LINE CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 MAIN ST UNITE #5
STURBRIDGE MA
01566-1556
US

IV. Provider business mailing address

42 HILLSIDE DR
STURBRIDGE MA
01566-1536
US

V. Phone/Fax

Practice location:
  • Phone: 508-347-3033
  • Fax: 508-347-3033
Mailing address:
  • Phone: 508-347-9540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3003
License Number StateMA

VIII. Authorized Official

Name: DR. DAN L. MACUMBER
Title or Position: OWNER
Credential: D.C.
Phone: 508-347-3033