Provider Demographics
NPI:1306342951
Name:ROSLINDALE CENTER CHIROPRACTIC INC
Entity type:Organization
Organization Name:ROSLINDALE CENTER CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:857-203-9950
Mailing Address - Street 1:17 CORINTH ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3022
Mailing Address - Country:US
Mailing Address - Phone:857-203-9950
Mailing Address - Fax:857-203-9950
Practice Address - Street 1:17 CORINTH ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131
Practice Address - Country:US
Practice Address - Phone:857-203-9950
Practice Address - Fax:857-203-9950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty