Provider Demographics
NPI:1376763383
Name:ACUPUNCTURE & CHIROPRACTIC CLINIC LLC.
Entity type:Organization
Organization Name:ACUPUNCTURE & CHIROPRACTIC CLINIC LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-399-8880
Mailing Address - Street 1:668 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-5625
Mailing Address - Country:US
Mailing Address - Phone:508-399-8881
Mailing Address - Fax:
Practice Address - Street 1:668 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-5625
Practice Address - Country:US
Practice Address - Phone:508-399-8881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI404715OtherBLUE CHIP
MAY39931OtherBCBSMA GROUP
RI32964-4OtherBCBSRI
MAY36582OtherBCBSMA
MAY40121OtherBCBSMA GROUP #
RI29905-5OtherBCBSRI
RI404715OtherBLUE CHIP
MAY40121OtherBCBSMA GROUP #