Provider Demographics
NPI:1174776058
Name:BUZZARDS BAY CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:BUZZARDS BAY CHIROPRACTIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-759-8852
Mailing Address - Street 1:196 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BUZZARDS BAY
Mailing Address - State:MA
Mailing Address - Zip Code:02532
Mailing Address - Country:US
Mailing Address - Phone:508-759-8852
Mailing Address - Fax:508-759-0192
Practice Address - Street 1:196 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BUZZARDS BAY
Practice Address - State:MA
Practice Address - Zip Code:02563
Practice Address - Country:US
Practice Address - Phone:508-759-8852
Practice Address - Fax:508-759-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1748111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4400497OtherUNITED HEALTHCARE
KY954853OtherAETNA
MA35264OtherHARVARD PILGRIM
TX954853OtherAETNA
MAY36232OtherBLUE CROSS BLUE SHIELD
MA1610627Medicaid
MA768825OtherTUFTS
GA4400497OtherUNITED HEALTHCARE
PA57566OtherCIGNA
MA768825OtherTUFTS
GA4400497OtherUNITED HEALTHCARE
MA35264OtherHARVARD PILGRIM