Healthcare Provider Details

I. General information

NPI: 1598882060
Provider Name (Legal Business Name): FAMILY CHIROPRACTIC OF WAKEFIELD CORNER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PROVINCE LAKE RD
SANBORNVILLE NH
03872-3900
US

IV. Provider business mailing address

40 PROVINCE LAKE RD
SANBORNVILLE NH
03872-3900
US

V. Phone/Fax

Practice location:
  • Phone: 603-522-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6580402
License Number StateNH

VIII. Authorized Official

Name: JANE E. SILCOCKS
Title or Position: PRESIDENT
Credential: DC
Phone: 603-522-3100