MEDICARE: DR. DAMON J GANGEMI D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1841	MA

General Provider Information

NPI Number	:	1720105075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAMON J GANGEMI D.C.

Provider Business Mailing Address
First Line	:	294 PLEASANT ST
Second Line	:	SUITE 104
City	:	STOUGHTON
State	:	MA
Zip	:	02072-2571
Country	:	US
Telephone Number	:	784-344-8878
Fax Number	:	781-344-0642

Provider Business Practice Location Address
First Line	:	294 PLEASANT ST
Second Line	:	SUITE 104
City	:	STOUGHTON
State	:	MA
Zip	:	02072-2571
Country	:	US
Telephone Number	:	784-344-8878
Fax Number	:	781-344-0642

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	04/11/2008

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