Provider Demographics
NPI:1194762476
Name:ROBERT W BARITZ, PC
Entity type:Organization
Organization Name:ROBERT W BARITZ, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-583-2565
Mailing Address - Street 1:450 PLEASANT ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2536
Mailing Address - Country:US
Mailing Address - Phone:508-583-2565
Mailing Address - Fax:508-580-2477
Practice Address - Street 1:450 PLEASANT ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2536
Practice Address - Country:US
Practice Address - Phone:508-583-2565
Practice Address - Fax:508-580-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY49018Medicare ID - Type Unspecified