Provider Demographics
NPI:1962607150
Name:KATRINA GURVITS DC PC
Entity type:Organization
Organization Name:KATRINA GURVITS DC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GURVITS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-232-0240
Mailing Address - Street 1:651 WASHINGTON ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4517
Mailing Address - Country:US
Mailing Address - Phone:614-232-0240
Mailing Address - Fax:617-232-0213
Practice Address - Street 1:651 WASHINGTON ST
Practice Address - Street 2:SUITE 110
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4517
Practice Address - Country:US
Practice Address - Phone:617-232-0240
Practice Address - Fax:617-232-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39538OtherBCBS GROUP #