=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669985537
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHESTNUT STREET CHIROPRACTIC & WELLBEING PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2017
-----------------------------------------------------
Last Update Date | 11/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 CHESTNUT ST STE A
-----------------------------------------------------
City | EXETER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03833-1850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-418-5050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 CHESTNUT ST APT 1302
-----------------------------------------------------
City | EXETER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03833-1858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-418-5050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CHIROPRACTOR
-----------------------------------------------------
Name | DR. NICHOLAS E ROST
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 603-418-5050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------