Healthcare Provider Details

I. General information

NPI: 1265506679
Provider Name (Legal Business Name): STEPHEN M DRISCOLL DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 LOVELLS LANE
MARSTONS MILLS MA
02648
US

IV. Provider business mailing address

153 LOVELLS LANE
MARSTONS MILLS MA
02648
US

V. Phone/Fax

Practice location:
  • Phone: 508-420-1160
  • Fax: 508-420-3245
Mailing address:
  • Phone: 508-420-1160
  • Fax: 508-420-3245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1206
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: