Provider Demographics
NPI:1184503625
Name:SUMMIT CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SUMMIT CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL CREATOR/OWNER OF LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:THIBODEAU
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:401-575-1771
Mailing Address - Street 1:168 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-6519
Mailing Address - Country:US
Mailing Address - Phone:401-575-1771
Mailing Address - Fax:
Practice Address - Street 1:168 MORGAN AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-6519
Practice Address - Country:US
Practice Address - Phone:401-575-1771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty