MEDICARE: ADVANCED CHIROPRACTIC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y39331	OTHER	MA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1881897783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CHIROPRACTIC

Provider Business Mailing Address
First Line	:	200 WALNUT STREET
Second Line	:
City	:	SAUGUS
State	:	MA
Zip	:	01906
Country	:	US
Telephone Number	:	781-233-7110
Fax Number	:	781-233-9740

Provider Business Practice Location Address
First Line	:	200 WALNUT ST
Second Line	:
City	:	SAUGUS
State	:	MA
Zip	:	01906-1158
Country	:	US
Telephone Number	:	781-233-7110
Fax Number	:	781-233-9740

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DWIGHT JOHN DEGEORGE
Credential	:	DC
Telephone Number	:	781-233-7110

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	08/22/2020

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Directions to “ADVANCED CHIROPRACTIC ” Practice Location

Language	Start Address	Practice Location

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