Provider Demographics
NPI:1700613171
Name:AQUIDNECK CHIROPRACTIC AND PERFORMANCE REHABILITATION
Entity type:Organization
Organization Name:AQUIDNECK CHIROPRACTIC AND PERFORMANCE REHABILITATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:D
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-849-7011
Mailing Address - Street 1:1272 W MAIN RD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-6405
Mailing Address - Country:US
Mailing Address - Phone:401-849-7011
Mailing Address - Fax:401-847-1449
Practice Address - Street 1:1272 WEST MAIN RD., BUILDING 2
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-6405
Practice Address - Country:US
Practice Address - Phone:401-849-7011
Practice Address - Fax:401-847-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty