# RIVERSIDE CHIROPRACTIC WELLNESS CENTERS, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Riverside Chiropractic Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023372067
- **Authorized official:** DR. REZA POURSHADI DC (PRESIDENT)
- **Authorized official phone:** (781) 395-0003

## Contact information

- **Practice address:** 65 RIVERSIDE AVE STE C, MEDFORD, MA 02155-4653
- **Practice address phone:** (781) 395-0003
- **Practice address fax:** (781) 395-2223
- **Mailing address:** 181 TAFT RD, WILMINGTON, MA 01887-2820
- **Mailing address phone:** (781) 395-0003
- **Mailing address fax:** (781) 395-2223

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 2413 | MA | Yes |

## Other

- **Enumeration date:** 06/25/2012
- **Last updated:** 06/25/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1697218 | — | MA |