Healthcare Provider Details

I. General information

NPI: 1295721660
Provider Name (Legal Business Name): LAWRENCE BRONSTEIN DC CNS DACBN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MAHAIWE ST
GREAT BARRINGTON MA
01230-1901
US

IV. Provider business mailing address

15 MAHAIWE ST
GREAT BARRINGTON MA
01230-1901
US

V. Phone/Fax

Practice location:
  • Phone: 413-528-2948
  • Fax: 413-528-5404
Mailing address:
  • Phone: 413-528-2948
  • Fax: 413-528-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1597
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: