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General NPI Number Information
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NPI Number | 1255791570
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Entity Type | Organization
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Legal Business Name | ALTA CHIROPRACTIC INC
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 922 WALTHAM ST SUITE 201
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City | LEXINGTON
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State | MA
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Zip | 02421-8019
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Country | US
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Telephone | 781-863-0583
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Fax | 781-863-0584
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Provider Business Mailing Address
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Address Line | 922 WALTHAM ST SUITE 201
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City | LEXINGTON
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State | MA
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Zip | 02421-8019
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Country | US
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Telephone | 781-863-0583
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Fax | 781-863-0584
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUSAN E CONLEY
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Credential | DC
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Telephone | 781-863-0583
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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 | CH2767
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License Number State | MA
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