Provider Demographics
NPI:1285811885
Name:CHIROPRACTIC & SPORTS SERVICES OF BOSTON
Entity type:Organization
Organization Name:CHIROPRACTIC & SPORTS SERVICES OF BOSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-268-0333
Mailing Address - Street 1:14 DORCHESTER ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-2154
Mailing Address - Country:US
Mailing Address - Phone:617-268-0333
Mailing Address - Fax:617-268-0445
Practice Address - Street 1:14 DORCHESTER ST STE 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-2154
Practice Address - Country:US
Practice Address - Phone:617-268-0333
Practice Address - Fax:617-268-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU83729Medicare UPIN