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General NPI Number Information
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NPI Number | 1245201649
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Entity Type | Individual
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Provider Name | BENJAMIN THOMAS ANDRULOT D.C.
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Gender | Male
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 47 MAIN ST
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City | ORLEANS
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State | MA
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Zip | 02653-2424
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Country | US
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Telephone | 508-240-7600
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Fax | 508-240-7686
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Provider Business Mailing Address
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Address Line | 40 BLUE ROCK RD
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City | SOUTH YARMOUTH
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State | MA
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Zip | 02664-1333
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Country | US
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Telephone | 508-240-7600
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Fax | 508-240-7686
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 2879
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License Number State | MA
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