=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376604918
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 UNION ST
-----------------------------------------------------
City | WEST SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01089-4115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-734-6245
-----------------------------------------------------
Fax | 413-734-5368
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 425 UNION ST
-----------------------------------------------------
City | WEST SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01089-4115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-734-6245
-----------------------------------------------------
Fax | 413-734-5368
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RANSOM J MORIN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 413-734-6245
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2878
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------