Provider Demographics
NPI:1053576785
Name:WEBSTER LAKE CHIROPRACTIC
Entity type:Organization
Organization Name:WEBSTER LAKE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:KERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-949-6900
Mailing Address - Street 1:325 THOMPSON RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-1504
Mailing Address - Country:US
Mailing Address - Phone:508-949-6900
Mailing Address - Fax:508-949-2000
Practice Address - Street 1:325 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-1504
Practice Address - Country:US
Practice Address - Phone:508-949-6900
Practice Address - Fax:508-949-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty