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General NPI Number Information
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NPI Number | 1366940231
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC NATURALLY, INC.
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 337 BELGRADE AVE
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City | ROSLINDALE
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State | MA
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Zip | 02131-2757
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Country | US
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Telephone | 857-273-4162
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Fax | 857-273-3946
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Provider Business Mailing Address
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Address Line | 337 BELGRADE AVE
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City | ROSLINDALE
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State | MA
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Zip | 02131-2757
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Country | US
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Telephone | 857-273-4162
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Fax | 857-273-3946
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARSELLA L IMONTI
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Credential | DC
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Telephone | 857-273-4162
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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 | 3184
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License Number State | MA
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