Healthcare Provider Details

I. General information

NPI: 1316449564
Provider Name (Legal Business Name): QUALITY CHIROPRACTIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2018
Last Update Date: 03/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MILTON ST
WORCESTER MA
01606-2819
US

IV. Provider business mailing address

65 MILTON ST
WORCESTER MA
01606-2819
US

V. Phone/Fax

Practice location:
  • Phone: 508-459-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1512
License Number StateMA

VIII. Authorized Official

Name: MR. MARTIN CHOMA
Title or Position: MANAGER
Credential:
Phone: 508-459-9800