MEDICARE: CANCRO CHIROPRACTIC 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	2046	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	792417	OTHER	MA	TUFTS
2	Y36441	OTHER	MA	BCBS
3	2196431	OTHER		CIGNA
4	350056	OTHER		HPH

General Provider Information

NPI Number	:	1851401442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANCRO CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	18 STATION AVE
Second Line	:	UNIT A
City	:	NEWTON
State	:	MA
Zip	:	02461-2280
Country	:	US
Telephone Number	:	617-244-3330
Fax Number	:	617-244-3309

Provider Business Practice Location Address
First Line	:	18 STATION AVE
Second Line	:	UNIT A
City	:	NEWTON
State	:	MA
Zip	:	02461-1222
Country	:	US
Telephone Number	:	617-244-3330
Fax Number	:	617-244-3309

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOANNE CANCRO
Credential	:	DC
Telephone Number	:	617-244-3330

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	10/28/2016

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