Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3694 | MA |
NPI | 1003431339 |
---|---|
Provider Name | Dr. Brandon Smolarek |
First Address | Northborough, MA 01532-2382 |
Second Address | Northborough, MA 01532-2382 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2020 |
Last Update Date | 12/06/2020 |