Healthcare Provider Details

I. General information

NPI: 1659040228
Provider Name (Legal Business Name): ESPANOLA CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S MAIN ST
WOONSOCKET RI
02895-4227
US

IV. Provider business mailing address

125 S MAIN ST
WOONSOCKET RI
02895-4227
US

V. Phone/Fax

Practice location:
  • Phone: 140-176-6700
  • Fax: 401-766-7001
Mailing address:
  • Phone: 140-176-6700
  • Fax: 401-766-7001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW ESPANOLA
Title or Position: OWNER-CHIROPRACTIC
Credential: DC
Phone: 401-766-7000