Provider Demographics
NPI:1154592624
Name:PLYMOUTH CHIROPRACTIC
Entity type:Organization
Organization Name:PLYMOUTH CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANDSEADEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-536-2221
Mailing Address - Street 1:31 ROUTE 25 UNIT 1
Mailing Address - Street 2:VALLEY CENTER
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-3159
Mailing Address - Country:US
Mailing Address - Phone:603-536-2221
Mailing Address - Fax:603-536-7628
Practice Address - Street 1:31 ROUTE 25 UNIT 1
Practice Address - Street 2:VALLEY CENTER
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3159
Practice Address - Country:US
Practice Address - Phone:603-536-2221
Practice Address - Fax:603-536-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7450705111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE8423Medicare UPIN