Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2879 | MA |
NPI | 1245201649 |
---|---|
Provider Name | Dr. Benjamin Thomas Andrulot |
First Address | South Yarmouth, MA 02664-1333 |
Second Address | Orleans, MA 02653-2424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1600541 | MASSHEALTH (01) | MA |
1660669 | CIGNA HEALTHCARE (01) | MA |
7335964 | AETNA HEALTHCARE (01) | MA |
AA80633 | HARVARD PILGRIM HEALTH (01) | MA |
U98939 | (02) | MA |
Y37048 | BCBS OF MA (01) | MA |