Healthcare Provider Details

I. General information

NPI: 1154380087
Provider Name (Legal Business Name): RICHARD MICHAEL DANUBIO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 LOWELL ST
PEABODY MA
01960-1385
US

IV. Provider business mailing address

474 LOWELL ST
PEABODY MA
01960-1385
US

V. Phone/Fax

Practice location:
  • Phone: 978-536-3111
  • Fax: 978-536-7477
Mailing address:
  • Phone: 978-536-3111
  • Fax: 978-536-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number629
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: