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General NPI Number Information
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NPI Number | 1043489313
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Entity Type | Organization
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Legal Business Name | BAY STATE CHIROPRACTIC & SPORTS INJURIES, INC.
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 69 S MAIN ST
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City | MIDDLETON
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State | MA
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Zip | 01949-2213
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Country | US
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Telephone | 978-777-2737
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Fax | 978-777-5351
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Provider Business Mailing Address
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Address Line | 283 S BROADWAY
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City | LAWRENCE
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State | MA
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Zip | 01843-2631
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Country | US
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Telephone | 978-688-9122
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Fax | 978-688-9871
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. MICHAEL JOSEPH DIMAURO
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Credential | D.C.
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Telephone | 978-688-9122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 1905
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License Number State | MA
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