Provider Demographics
NPI:1902146434
Name:BOSTON CHIROPRACTIC AT CAMBRIDGE LLC
Entity type:Organization
Organization Name:BOSTON CHIROPRACTIC AT CAMBRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:CARMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-850-2846
Mailing Address - Street 1:218 COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4451
Mailing Address - Country:US
Mailing Address - Phone:954-850-8246
Mailing Address - Fax:954-495-9111
Practice Address - Street 1:883 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1430
Practice Address - Country:US
Practice Address - Phone:617-945-1530
Practice Address - Fax:617-945-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty