Provider Demographics
NPI:1215344296
Name:NEW ENGLAND CHIROPRACTIC CENTER, LLC
Entity type:Organization
Organization Name:NEW ENGLAND CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLESAR FABRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-337-5684
Mailing Address - Street 1:255 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2261
Mailing Address - Country:US
Mailing Address - Phone:401-337-5684
Mailing Address - Fax:401-337-9290
Practice Address - Street 1:255 HOPE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2261
Practice Address - Country:US
Practice Address - Phone:401-337-5684
Practice Address - Fax:401-337-9290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty