MEDICARE: OCEAN STATE CHIROPRACTIC AND SPORTS REHABILITATION 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

General Provider Information

NPI Number	:	1841156205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCEAN STATE CHIROPRACTIC AND SPORTS REHABILITATION INC

Provider Business Mailing Address
First Line	:	10 COMMERCIAL ST
Second Line	:
City	:	FOXBOROUGH
State	:	MA
Zip	:	02035-2509
Country	:	US
Telephone Number	:	858-752-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 ANNANDALE RD
Second Line	:
City	:	NEWPORT
State	:	RI
Zip	:	02840-3601
Country	:	US
Telephone Number	:	858-752-9500
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL GERALD LEROUX
Credential	:	DC
Telephone Number	:	858-752-9500

Provider Enumeration Date	:	12/30/2025
Last Update Date	:	12/30/2025

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