Healthcare Provider Details

I. General information

NPI: 1275699795
Provider Name (Legal Business Name): CATHARINE JEAN GUERTIN D.C., M-PAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 DILLABUR AVE
NORTH KINGSTOWN RI
02852-1009
US

IV. Provider business mailing address

20 JEFFERSON AVE
CHICOPEE MA
01020-1034
US

V. Phone/Fax

Practice location:
  • Phone: 413-592-2828
  • Fax:
Mailing address:
  • Phone: 413-348-8019
  • Fax: 413-533-5028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number2909
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00541
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: