MEDICARE: LOGAN CHIROPRACTIC 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	228084	MA
2	111N00000X	Chiropractor	105599	MA

General Provider Information

NPI Number	:	1558372540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOGAN CHIROPRACTIC INC

Provider Business Mailing Address
First Line	:	25 MAVERICK SQ
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02128-2312
Country	:	US
Telephone Number	:	617-567-3300
Fax Number	:	617-567-8500

Provider Business Practice Location Address
First Line	:	25 MAVERICK SQ
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02128-2312
Country	:	US
Telephone Number	:	617-567-3300
Fax Number	:	617-567-8500

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KENNETH RAMOS
Credential	:
Telephone Number	:	617-567-3300

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	05/11/2011

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Directions to “LOGAN CHIROPRACTIC INC ” Practice Location

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