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General NPI Number Information
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NPI Number | 1790821387
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Entity Type | Organization
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Legal Business Name | ALDENVILLE CHIROPRACTIC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 755 GRATTAN ST
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City | CHICOPEE
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State | MA
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Zip | 01020-1238
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Country | US
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Telephone | 413-532-1040
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Fax | 413-536-0320
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Provider Business Mailing Address
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Address Line | 755 GRATTAN ST
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City | CHICOPEE
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State | MA
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Zip | 01020-1238
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Country | US
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Telephone | 413-532-1040
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Fax | 413-536-0320
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. CHARLES EDWARD SAMSON
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Credential | D.C.
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Telephone | 413-532-1040
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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 | 1092
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 919
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License Number State | MA
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