Healthcare Provider Details

I. General information

NPI: 1689714180
Provider Name (Legal Business Name): AERIE CHIROPRACTIC LTD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 TEATICKET HWY
TEATICKET MA
02536-6545
US

IV. Provider business mailing address

433 TEATICKET HWY
TEATICKET MA
02536-6545
US

V. Phone/Fax

Practice location:
  • Phone: 508-548-7722
  • Fax: 508-548-7722
Mailing address:
  • Phone: 508-548-7722
  • Fax: 508-548-7722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number712
License Number StateMA

VIII. Authorized Official

Name: DR. LISA ANN ESPERSON
Title or Position: PRESIDENT
Credential: DC
Phone: 508-548-7722