Healthcare Provider Details

I. General information

NPI: 1265581557
Provider Name (Legal Business Name): JOHN RICHARD DAOUST DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 EAST ST
HINGHAM MA
02043-2009
US

IV. Provider business mailing address

328 EAST ST
HINGHAM MA
02043-2009
US

V. Phone/Fax

Practice location:
  • Phone: 781-740-1130
  • Fax:
Mailing address:
  • Phone: 781-740-1130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1352
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: