Provider Demographics
NPI:1407971120
Name:CHIROPRACTIC SOUTHEAST INC
Entity type:Organization
Organization Name:CHIROPRACTIC SOUTHEAST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PYNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:508-238-8521
Mailing Address - Street 1:479 TURNPIKE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375
Mailing Address - Country:US
Mailing Address - Phone:508-238-8521
Mailing Address - Fax:508-238-8523
Practice Address - Street 1:479 TURNPIKE ST
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375
Practice Address - Country:US
Practice Address - Phone:508-238-8521
Practice Address - Fax:508-238-8523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1612123Medicaid
MA35394OtherPILGRIM
MA712236OtherTUFTS
MA35394OtherPILGRIM
MAT58455Medicare ID - Type Unspecified