Healthcare Provider Details

I. General information

NPI: 1669473997
Provider Name (Legal Business Name): DANIEL JOSEPH FANSELOW D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 COLONIAL DR SUITE 1
WESTBORO MA
01581-1407
US

IV. Provider business mailing address

6 COLONIAL DR SUITE 1
WESTBORO MA
01581-1407
US

V. Phone/Fax

Practice location:
  • Phone: 508-366-3333
  • Fax: 508-366-3860
Mailing address:
  • Phone: 508-366-3333
  • Fax: 508-366-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number1420
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number000803
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberX005816
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: