MEDICARE: CHIROCARE ASSOCIATES, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2830	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0005495	OTHER	MA	MEDICARE PTAN

General Provider Information

NPI Number	:	1235380460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROCARE ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	64G CONCORD ST
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-2179
Country	:	US
Telephone Number	:	781-488-3388
Fax Number	:	781-488-3363

Provider Business Practice Location Address
First Line	:	64G CONCORD ST
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-2179
Country	:	US
Telephone Number	:	781-488-3388
Fax Number	:	781-488-3363

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. KEITH M PURI
Credential	:	D.C.
Telephone Number	:	781-488-3388

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	10/07/2008

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