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General NPI Number Information
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NPI Number | 1164821963
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Entity Type | Organization
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Legal Business Name | SPORT AND SPINE CHIROPRACTIC PC
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 11/04/2014
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Provider Practice Location Address
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Address Line | 185 LINCOLN ST #110
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City | HINGHAM
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State | MA
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Zip | 02043-1743
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Country | US
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Telephone | 781-741-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 19 BAY RIDGE RD
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City | SCITUATE
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State | MA
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Zip | 02066-3501
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Country | US
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Telephone | 781-741-5300
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LOREN REES
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Credential | D.C.
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Telephone | 741-741-5300
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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 | 3059
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 3059
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License Number State | MA
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