Healthcare Provider Details

I. General information

NPI: 1790936961
Provider Name (Legal Business Name): DEGANGE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 SOUTH ST
CONCORD NH
03301-3772
US

IV. Provider business mailing address

14 SOUTH ST
CONCORD NH
03301-3772
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-5551
  • Fax: 603-224-5552
Mailing address:
  • Phone: 603-224-5551
  • Fax: 603-224-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7071103
License Number StateNH

VIII. Authorized Official

Name: DR. CHRISTANA JEAN DEGANGE
Title or Position: OWNER
Credential: DC
Phone: 603-224-5551