Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1302 | MA |
NPI | 1255348090 |
---|---|
Provider Name | Dr. John Anthony Lacoste |
First Address | Centerville, MA 02632 |
Second Address | Centerville, MA 02632-2433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 24/01/2019 |