Provider Demographics
NPI:1457422115
Name:SHORELINE SPINE & PAIN ASSOCIATES, P.C.
Entity type:Organization
Organization Name:SHORELINE SPINE & PAIN ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:BORGES
Authorized Official - Last Name:FURTADO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-529-5436
Mailing Address - Street 1:2415 BOSTON POST RD
Mailing Address - Street 2:UNIT 11
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-4348
Mailing Address - Country:US
Mailing Address - Phone:401-529-5436
Mailing Address - Fax:
Practice Address - Street 1:2415 BOSTON POST RD
Practice Address - Street 2:UNIT 11
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-4348
Practice Address - Country:US
Practice Address - Phone:401-529-5436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT05-0001647CT01OtherANTHEM BLUE CROSS
CT11513740OtherCAQH
CT05-0001647CT01OtherANTHEM BLUE CROSS