Provider Demographics
NPI:1194928820
Name:CENTRE CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:CENTRE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:AMARANTOS
Authorized Official - Last Name:APAZIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-327-8552
Mailing Address - Street 1:1765 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:WEST ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132-1535
Mailing Address - Country:US
Mailing Address - Phone:617-327-8552
Mailing Address - Fax:617-327-8312
Practice Address - Street 1:1765 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1535
Practice Address - Country:US
Practice Address - Phone:617-327-8552
Practice Address - Fax:617-327-8312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1609262Medicaid
MA1316039399OtherNPI
MA1609262Medicaid
MA1316039399OtherNPI