Provider Demographics
NPI:1306354246
Name:TIERNEY CHIROPRACTIC
Entity type:Organization
Organization Name:TIERNEY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:TIERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-942-3660
Mailing Address - Street 1:301 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3616
Mailing Address - Country:US
Mailing Address - Phone:781-942-3660
Mailing Address - Fax:781-942-3660
Practice Address - Street 1:301 MAIN ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3616
Practice Address - Country:US
Practice Address - Phone:781-942-3660
Practice Address - Fax:781-942-3660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110030354AMedicaid