Provider Demographics
NPI:1104099720
Name:PIONEER CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:PIONEER CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:C
Authorized Official - Last Name:BREED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:413-746-0633
Mailing Address - Street 1:PO BOX 81095
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01138-1095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:413-747-0166
Practice Address - Street 1:250 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-2024
Practice Address - Country:US
Practice Address - Phone:413-746-0633
Practice Address - Fax:413-747-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation