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General NPI Number Information
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NPI Number | 1255661898
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Entity Type | Organization
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Legal Business Name | WILMINGTON FAMILY CHIROPRACTIC AND WELLNESS CENTER, INC.
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Dates
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Enumeration Date | 01/04/2010
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 7 MIDDLESEX AVE
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City | WILMINGTON
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State | MA
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Zip | 01887
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Country | US
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Telephone | 978-658-7590
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Fax | 978-658-7594
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Provider Business Mailing Address
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Address Line | 7 MIDDLESEX AVE
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City | WILMINGTON
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State | MA
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Zip | 01887-2758
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Country | US
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Telephone | 978-658-7590
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Fax | 978-658-7594
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN JENSEN
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Credential | D.C.
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Telephone | 978-658-7590
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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 | 1956
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License Number State | MA
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