Healthcare Provider Details

I. General information

NPI: 1821197328
Provider Name (Legal Business Name): GREAT MARSH CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 MAIN ST
WEST BARNSTABLE MA
02668-1152
US

IV. Provider business mailing address

PO BOX 122
WEST BARNSTABLE MA
02668-0122
US

V. Phone/Fax

Practice location:
  • Phone: 508-362-4533
  • Fax: 508-362-5151
Mailing address:
  • Phone: 508-362-4533
  • Fax: 508-362-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number419
License Number StateMA

VIII. Authorized Official

Name: DR. JOHN C DORISS
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 508-362-4533