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General NPI Number Information
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NPI Number | 1013245356
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Entity Type | Organization
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Legal Business Name | OCEAN STATE CHIROPRACTIC AND SPORTS REHABILITATION INC
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 3030 E MAIN RD
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City | PORTSMOUTH
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State | RI
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Zip | 02871-4243
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Country | US
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Telephone | 401-324-0600
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Fax | 401-354-7470
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Provider Business Mailing Address
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Address Line | 1920 MINERAL SPRING AVE UNIT 16
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-3742
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Country | US
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Telephone | 401-354-5500
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Fax | 401-354-7470
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Authorized Official
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Title or Position | OWNER, CHIROPRACTOR
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Name | MICHAEL GERALD LEROUX
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Credential | DC
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Telephone | 401-324-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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