Healthcare Provider Details

I. General information

NPI: 1902857394
Provider Name (Legal Business Name): LAURA VIRGINIA GODFREY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 BOSTON ST SUITE 212/214
TOPSFIELD MA
01983-2215
US

IV. Provider business mailing address

239 BOSTON ST SUITE 212/214
TOPSFIELD MA
01983-2215
US

V. Phone/Fax

Practice location:
  • Phone: 978-887-9889
  • Fax: 978-360-6023
Mailing address:
  • Phone: 978-887-9889
  • Fax: 978-360-6023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2330
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: