Healthcare Provider Details

I. General information

NPI: 1174776058
Provider Name (Legal Business Name): BUZZARDS BAY CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 MAIN STREET
BUZZARDS BAY MA
02563
US

IV. Provider business mailing address

196 MAIN STREET
BUZZARDS BAY MA
02532
US

V. Phone/Fax

Practice location:
  • Phone: 508-759-8852
  • Fax: 508-759-0192
Mailing address:
  • Phone: 508-759-8852
  • Fax: 508-759-0192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMA1748
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberMA1748
License Number StateMA

VIII. Authorized Official

Name: DR. DAVID C FISHER
Title or Position: OWNER/PHYSICIAN
Credential: D.C.
Phone: 508-759-8852