MEDICARE: DR. BRIAN JOSEPH BAZIN DC

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	3597	MA

General Provider Information

NPI Number	:	1821504358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN JOSEPH BAZIN DC

Provider Business Mailing Address
First Line	:	200 N MAIN ST STE 10
Second Line	:
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-2353
Country	:	US
Telephone Number	:	413-525-2932
Fax Number	:	413-525-6839

Provider Business Practice Location Address
First Line	:	200 N MAIN ST STE 10
Second Line	:
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-2353
Country	:	US
Telephone Number	:	413-525-2932
Fax Number	:	413-525-6839

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

Provider Enumeration Date	:	12/20/2017
Last Update Date	:	09/08/2021

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