Provider Demographics
NPI:1053517078
Name:ESSENTIAL CARE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ESSENTIAL CARE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-284-1661
Mailing Address - Street 1:454 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3034
Mailing Address - Country:US
Mailing Address - Phone:781-284-1661
Mailing Address - Fax:781-823-6550
Practice Address - Street 1:454 BROADWAY
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3034
Practice Address - Country:US
Practice Address - Phone:781-284-1661
Practice Address - Fax:781-823-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39584OtherBLUE CROSS OF MA GROUP #
MAY39584OtherBLUE CROSS OF MA GROUP #