Healthcare Provider Details

I. General information

NPI: 1659617314
Provider Name (Legal Business Name): HEALTHSOURCE OF AUBURN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MIDSTATE DR
AUBURN MA
01501-1858
US

IV. Provider business mailing address

19 MIDSTATE DR
AUBURN MA
01501-1858
US

V. Phone/Fax

Practice location:
  • Phone: 508-832-5050
  • Fax:
Mailing address:
  • Phone: 508-832-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3402
License Number StateMA

VIII. Authorized Official

Name: DR. RICHARD A MUGAVERO
Title or Position: CHIROPRACTOR OF RECORD
Credential: D.C.
Phone: 978-521-7111