Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3400 | MA |
NPI | 1003158734 |
---|---|
Provider Name | Brendan Riordan |
First Address | Norwell, MA 02061 |
Second Address | Norwell, MA 02061-1903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 20/03/2013 |