Healthcare Provider Details

I. General information

NPI: 1013128404
Provider Name (Legal Business Name): SOLEY CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 COURT ST STE 1
WESTFIELD MA
01085-3521
US

IV. Provider business mailing address

PO BOX 890
GRANBY MA
01033-0890
US

V. Phone/Fax

Practice location:
  • Phone: 413-562-3615
  • Fax:
Mailing address:
  • Phone: 413-569-9188
  • Fax: 413-569-6493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1912
License Number StateMA

VIII. Authorized Official

Name: JEFFREY SOLEY
Title or Position: OWNER
Credential:
Phone: 413-562-3615