Provider Demographics
NPI:1518266246
Name:PROACTIVE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:PROACTIVE CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MEAGHAN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-847-1412
Mailing Address - Street 1:175 ELM ST
Mailing Address - Street 2:APT REAR
Mailing Address - City:SALISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01952-1827
Mailing Address - Country:US
Mailing Address - Phone:508-847-1412
Mailing Address - Fax:
Practice Address - Street 1:167 ELM ST
Practice Address - Street 2:SUITE 9
Practice Address - City:SALISBURY
Practice Address - State:MA
Practice Address - Zip Code:01952-1815
Practice Address - Country:US
Practice Address - Phone:508-847-1412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1520001Medicare PIN