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General NPI Number Information
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NPI Number | 1487962262
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Entity Type | Organization
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Legal Business Name | ASHMONT CHIROPRACTIC CENTER, INC.
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 2044 DORCHESTER AVE
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City | DORCHESTER CENTER
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State | MA
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Zip | 02124-4704
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Country | US
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Telephone | 617-265-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 2044 DORCHESTER AVE
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City | DORCHESTER CENTER
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State | MA
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Zip | 02124-4704
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Country | US
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Telephone | 617-265-2900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN G THOMPSON
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Credential | DC
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Telephone | 617-265-2900
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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 | 171
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License Number State | MA
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