MEDICARE: NAUSET 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	1862	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y36364	OTHER	MA	BC/BS

General Provider Information

NPI Number	:	1588649420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAUSET CHIROPRACTIC, INC.

Provider Business Mailing Address
First Line	:	177 RT 6A
Second Line	:
City	:	ORLEANS
State	:	MA
Zip	:	02653-3206
Country	:	US
Telephone Number	:	508-240-1037
Fax Number	:	508-240-6843

Provider Business Practice Location Address
First Line	:	177 RT 6A
Second Line	:
City	:	ORLEANS
State	:	MA
Zip	:	02653-3206
Country	:	US
Telephone Number	:	508-240-1037
Fax Number	:	508-240-6843

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	DR. MARK D GRIFFIN
Credential	:	D.C.
Telephone Number	:	508-240-1037

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	08/22/2020

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