MEDICARE: B.R. CHIROPRACTIC MANAGEMENT, INC

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	1930	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y39388	OTHER	MA	BC & BS GROUP
2	Y36382	OTHER	MA	BC & BS INDIVIDUAL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275696767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B.R. CHIROPRACTIC MANAGEMENT, INC

Provider Business Mailing Address
First Line	:	25 MARSTON ST STE 205
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01841-2357
Country	:	US
Telephone Number	:	978-687-7117
Fax Number	:	978-687-7417

Provider Business Practice Location Address
First Line	:	25 MARSTON ST STE 205
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01841-2357
Country	:	US
Telephone Number	:	978-687-7117
Fax Number	:	978-687-7417

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK SOFIA
Credential	:	DC
Telephone Number	:	978-687-7117

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	01/16/2024

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