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General NPI Number Information
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NPI Number | 1902070121
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Entity Type | Organization
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Legal Business Name | GANGEMI CHIROPRACTIC PC
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 294 PLEASANT ST SUITE 104
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City | STOUGHTON
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State | MA
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Zip | 02072-2571
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Country | US
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Telephone | 781-344-8878
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Fax | 781-344-0642
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Provider Business Mailing Address
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Address Line | 294 PLEASANT ST SUITE 104
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City | STOUGHTON
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State | MA
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Zip | 02072-2571
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Country | US
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Telephone | 781-344-8878
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Fax | 781-344-0642
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAMON JOHN GANGEMI
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Credential | D.C.
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Telephone | 781-344-8878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1841
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License Number State | MA
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