Healthcare Provider Details

I. General information

NPI: 1376661017
Provider Name (Legal Business Name): DANNY MAX HARGROVE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 PLEASANT ST SUITE 715
PAXTON MA
01612-1380
US

IV. Provider business mailing address

679 PLEASANT ST SUITE 715
PAXTON MA
01612-1380
US

V. Phone/Fax

Practice location:
  • Phone: 508-792-2990
  • Fax: 508-792-2996
Mailing address:
  • Phone: 508-792-2990
  • Fax: 508-792-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2295
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: