Provider Demographics
NPI:1053364604
Name:VILLAGE FAMILY CHIROPRACTIC OF BROOKLINE, LLC
Entity type:Organization
Organization Name:VILLAGE FAMILY CHIROPRACTIC OF BROOKLINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JAYNE
Authorized Official - Last Name:GEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:617-566-2001
Mailing Address - Street 1:126 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6468
Mailing Address - Country:US
Mailing Address - Phone:617-566-2001
Mailing Address - Fax:617-566-2007
Practice Address - Street 1:126 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6468
Practice Address - Country:US
Practice Address - Phone:617-566-2001
Practice Address - Fax:617-566-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3034111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty