Provider Demographics
NPI:1255405437
Name:METACOM CHIROPRACTIC CENTRE, INC
Entity type:Organization
Organization Name:METACOM CHIROPRACTIC CENTRE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:V
Authorized Official - Last Name:ALANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-253-1130
Mailing Address - Street 1:450 HOPE ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-1834
Mailing Address - Country:US
Mailing Address - Phone:401-253-1130
Mailing Address - Fax:401-253-8320
Practice Address - Street 1:450 HOPE ST
Practice Address - Street 2:2ND FL
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-1834
Practice Address - Country:US
Practice Address - Phone:401-253-1130
Practice Address - Fax:401-253-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI359003113Medicare ID - Type UnspecifiedMEDICARE GRP NUMBER