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General NPI Number Information
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NPI Number | 1104068048
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Entity Type | Organization
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Legal Business Name | DORCHESTER CHIROPRACTIC & REHABILITATION CENTER INC
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Dates
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Enumeration Date | 03/24/2009
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 612A BLUE HILL AVE
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City | DORCHESTER
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State | MA
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Zip | 02121-3212
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Country | US
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Telephone | 508-384-9424
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Fax | 800-540-3513
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Provider Business Mailing Address
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Address Line | 612A BLUE HILL AVE
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City | DORCHESTER
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State | MA
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Zip | 02121-3212
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Country | US
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Telephone | 617-436-7246
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANTHONY MAUGERE
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Credential |
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Telephone | 617-436-7246
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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 | 396
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License Number State | MA
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