Provider Demographics
NPI:1992752596
Name:EASTERN SHORE CHIROPRACTIC CENTER, L.L.C.
Entity type:Organization
Organization Name:EASTERN SHORE CHIROPRACTIC CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LAVIN
Authorized Official - Last Name:MOORADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:860-444-6363
Mailing Address - Street 1:377 COLMAN ST
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-3713
Mailing Address - Country:US
Mailing Address - Phone:860-444-6363
Mailing Address - Fax:860-443-3314
Practice Address - Street 1:377 COLMAN ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-3713
Practice Address - Country:US
Practice Address - Phone:860-444-6363
Practice Address - Fax:860-443-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty