Healthsource of Fall River Chiropractic and Progressive Wellness, PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3339 Issued in MA

Legal business name

HEALTHSOURCE OF FALL RIVER CHIROPRACTIC AND PROGRESSIVE WELLNESS, PC

Practice address

657 Pleasant St
Unit 9
Fall River, MA 02721-4323

Phone

(508) 677-2554

Fax

(508) 677-2553

NPI assigned

Oct 14, 2013

Last updated

Feb 25, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Todd Lewis Dersham, D.C.NPI 1437454097

Title

Owner/President

Phone

(508) 677-2554

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Todd Lewis Dersham, D.C.

  • Chiropractor
  • Rochester, MA
  • NPI 1437454097
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1381708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393286400000",
    "number": "1336577162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "657 PLEASANT ST",
            "address_2": "UNIT 9",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "027214323",
            "telephone_number": "508-677-2554",
            "fax_number": "508-677-2553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "657 PLEASANT ST",
            "address_2": "UNIT 9",
            "city": "FALL RIVER",
            "state": "MA",
            "postal_code": "027214323",
            "telephone_number": "508-677-2554",
            "fax_number": "508-677-2553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE OF FALL RIVER CHIROPRACTIC AND PROGRESSIVE WELLNESS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-14",
        "last_updated": "2014-02-25",
        "status": "A",
        "authorized_official_last_name": "DERSHAM",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "LEWIS",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "508-677-2554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MA",
            "license": "3339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Fall River, MA
• Providers in Fall River, MA by specialty
• Chiropractor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.