Provider Demographics
NPI:1063976165
Name:CHARLESTOWN CHIROPRACTIC
Entity type:Organization
Organization Name:CHARLESTOWN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-242-4476
Mailing Address - Street 1:175 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3225
Mailing Address - Country:US
Mailing Address - Phone:617-242-4476
Mailing Address - Fax:617-242-4444
Practice Address - Street 1:175 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3225
Practice Address - Country:US
Practice Address - Phone:617-242-4476
Practice Address - Fax:617-242-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty