=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861130387
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHAWLA CHIROPRACTIC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2022
-----------------------------------------------------
Last Update Date | 05/24/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 435 NEWBURY ST STE 208
-----------------------------------------------------
City | DANVERS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01923-1065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-334-5002
-----------------------------------------------------
Fax | 949-577-4658
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 125 PALOMINO DR
-----------------------------------------------------
City | NORTH ANDOVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01845-3379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-334-5002
-----------------------------------------------------
Fax | 949-577-4658
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. SUDEEP CHAWLA
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 617-334-5002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------