Provider Demographics
NPI:1023348703
Name:PEPIN, MICHAEL JEAN (DC CCSP, CSCS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JEAN
Last Name:PEPIN
Suffix:
Gender:M
Credentials:DC CCSP, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WAMPUM TRL
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-2213
Mailing Address - Country:US
Mailing Address - Phone:401-617-1001
Mailing Address - Fax:
Practice Address - Street 1:51 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:ATTLEBORO FALLS
Practice Address - State:MA
Practice Address - Zip Code:02763-1100
Practice Address - Country:US
Practice Address - Phone:508-316-8482
Practice Address - Fax:508-804-7158
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-03
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00600111N00000X, 111NR0400X, 111NS0005X
MA3646111NR0400X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation