Healthcare Provider Details

I. General information

NPI: 1730364316
Provider Name (Legal Business Name): GLOCESTER FAMILY CHIROPRACTIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 PUTNAM PIKE UNIT # 4
CHEPACHET RI
02814
US

IV. Provider business mailing address

712 PUTNAM PIKE UNIT # 4
CHEPACHET RI
02814
US

V. Phone/Fax

Practice location:
  • Phone: 401-309-4696
  • Fax: 401-568-0563
Mailing address:
  • Phone: 401-309-4696
  • Fax: 401-568-0563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDCP00536
License Number StateRI

VIII. Authorized Official

Name: DR. MATTHEW M STONE
Title or Position: OWNER/CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 401-309-4696