Healthcare Provider Details

I. General information

NPI: 1740369859
Provider Name (Legal Business Name): DAVID GELINEAU D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 LAKEVIEW AVE SUITE 2
DRACUT MA
01826-3324
US

IV. Provider business mailing address

1533 LAKEVIEW AVE SUITE 2
DRACUT MA
01826-3324
US

V. Phone/Fax

Practice location:
  • Phone: 978-453-2792
  • Fax:
Mailing address:
  • Phone: 978-453-2792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2856
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: