Healthcare Provider Details

I. General information

NPI: 1710323688
Provider Name (Legal Business Name): MORAMARCO CHIROPRACTIC OFFICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BALDWIN GREEN CMN SUITE 204
WOBURN MA
01801-1865
US

IV. Provider business mailing address

3 BALDWIN GREEN CMN SUITE 204
WOBURN MA
01801-1865
US

V. Phone/Fax

Practice location:
  • Phone: 781-938-8558
  • Fax:
Mailing address:
  • Phone: 781-938-8558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMA1139
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number8789
License Number StateMA

VIII. Authorized Official

Name: MARC MORAMARCO
Title or Position: CHIROPRACTOR/PRESIDENT
Credential: DC
Phone: 781-938-8558