Organization Active NPI

Chiropractic Health Group, PC

  • Chiropractor
  • Canton, MA
National Provider Identifier
1457405367
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1871MA Issued in MA
Legal business name
CHIROPRACTIC HEALTH GROUP, PC
Practice address
95 Washington St
Suite 416
Canton, MA 02021-4006
Phone
(781) 575-0100
Fax
(781) 821-9964
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Glenn Lee Dodes, D.C.NPI 1154421212
Title
President
Phone
(781) 575-0100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 1871MA MA Primary

Addresses

Primary practice location

95 Washington St
Suite 416
Canton, MA 02021-4006

Mailing address

95 Washington St
Suite 416
Canton, MA 02021-4006
Phone (781) 575-0100

Other identifiers 2

IdentifierTypeStateIssuer
612569OtherMATUFTS GROUP
Y39167OtherMABLUE CROSS GROUP

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120517000004 MA Part B Supplier - Clinic/Group Practice 6901069640 Receives reassigned benefits from 2 practitioners
Practice locations: Canton, MA

National Provider Directory

National Provider Directory

Locations

95 Washington St
Ste 416
Canton, MA 02021
Phone (781) 575-0100

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457405367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 WASHINGTON ST",
            "address_2": "SUITE 416",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020214006",
            "telephone_number": "781-575-0100",
            "fax_number": "781-821-9964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 WASHINGTON ST",
            "address_2": "SUITE 416",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020214006",
            "telephone_number": "781-575-0100",
            "fax_number": "781-821-9964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIROPRACTIC HEALTH GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DODES",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-575-0100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MA",
            "license": "1871MA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS GROUP",
            "identifier": "612569",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP",
            "identifier": "Y39167",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.