Provider Demographics
NPI:1427160688
Name:WOBURN FAMILY CHIROPRACTIC INC
Entity type:Organization
Organization Name:WOBURN FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:PENDOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-938-9400
Mailing Address - Street 1:20 CUMMINGS PARK
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801
Mailing Address - Country:US
Mailing Address - Phone:781-938-9400
Mailing Address - Fax:871-938-9323
Practice Address - Street 1:20 CUMMINGS PARK
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:781-938-9400
Practice Address - Fax:871-938-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA7544OtherHARVARD PILGRIM
MA1697021Medicaid
2611483OtherAETNA
460083OtherTUFTS
Y39772OtherBLUE CROSS BLUE SHIELD
AA7544OtherHARVARD PILGRIM
Y45439Medicare ID - Type Unspecified