=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225355571
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BT CHIROPRACTIC HEALTH CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2010
-----------------------------------------------------
Last Update Date | 04/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 990 DORCHESTER AVE
-----------------------------------------------------
City | DORCHESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02125-1314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-282-2922
-----------------------------------------------------
Fax | 617-224-9508
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 990 DORCHESTER AVE
-----------------------------------------------------
City | DORCHESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02125-1314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-282-2922
-----------------------------------------------------
Fax | 617-224-9508
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LAM THANH HANG
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 617-282-2922
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2916
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------