# CHARLES STREET FAMILY CHIROPRACTIC, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Charles Street Family Chiropractic & Physical Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770505273
- **Authorized official:** MS. TIANA CELESIA RD (OFFICE MANAGER)
- **Authorized official phone:** (617) 720-1992

## Contact information

- **Practice address:** 102 CHARLES ST, BOSTON, MA 02114-4607
- **Practice address phone:** (617) 720-1992
- **Practice address fax:** (617) 248-9916
- **Mailing address:** 102 CHARLES ST, BOSTON, MA 02114-4607
- **Mailing address phone:** (617) 720-1992
- **Mailing address fax:** (617) 248-9916

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 222 | MA | Yes |
| 133V00000X | Registered Dietitian | — | — | — |
| 174400000X | Specialist | — | — | — |

## Other

- **Enumeration date:** 07/24/2006
- **Last updated:** 04/01/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4258513 | AETNA | — |
| 01 | — | 5190774 | CIGNA GROUP NUMBER | — |
| 01 | — | 641432 | TUFTS GROUP NUMBER | — |
| 01 | — | Y39316 | BCBS GROUP NUMBER | MA |