Healthcare Provider Details

I. General information

NPI: 1871879528
Provider Name (Legal Business Name): CHIROPRACTIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1196 ELMWOOD AVE
PROVIDENCE RI
02907-3716
US

IV. Provider business mailing address

1196 ELMWOOD AVE
PROVIDENCE RI
02907-3716
US

V. Phone/Fax

Practice location:
  • Phone: 401-461-1600
  • Fax: 401-461-3500
Mailing address:
  • Phone: 401-461-1600
  • Fax: 401-461-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDCP00545
License Number StateRI

VIII. Authorized Official

Name: DR. GREGG ALLEN MEDEIROS
Title or Position: CO-FOUNDER
Credential: D.C.
Phone: 401-461-1600