=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215069745
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD EDWARD TATE D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2007
-----------------------------------------------------
Last Update Date | 10/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 MALL ROAD SUITE G-12
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-272-5200
-----------------------------------------------------
Fax | 781-272-5260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 GLENRIDGE DR
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01730-2009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-275-4736
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH927
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------