Provider Demographics
NPI:1710180757
Name:SALEM CHIROPRACTIC CENTER, PC
Entity type:Organization
Organization Name:SALEM CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KNEELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-898-0030
Mailing Address - Street 1:58 RANGE RD STE R-03
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-2026
Mailing Address - Country:US
Mailing Address - Phone:603-898-0030
Mailing Address - Fax:603-894-6343
Practice Address - Street 1:58 RANGE RD STE R-03
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-2026
Practice Address - Country:US
Practice Address - Phone:603-898-0030
Practice Address - Fax:603-894-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH733402OtherTUFTS
NH733402OtherTUFTS