Provider Demographics
NPI:1730206046
Name:SHERRY MORRISSETTE DC,PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SHERRY MORRISSETTE DC,PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACNB
Authorized Official - Phone:401-397-9948
Mailing Address - Street 1:16A NOOSENECK HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02817-1511
Mailing Address - Country:US
Mailing Address - Phone:401-397-9948
Mailing Address - Fax:401-397-6218
Practice Address - Street 1:16A NOOSENECK HILL ROAD
Practice Address - Street 2:
Practice Address - City:WEST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02817-1511
Practice Address - Country:US
Practice Address - Phone:401-397-9948
Practice Address - Fax:401-397-6218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00351111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
359021379Medicare PIN
RI485319Medicare UPIN