Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2359 | MA |
NPI | 1225169766 |
---|---|
Provider Name | Dr. Jon Clyde Breed |
First Address | Wales, MA 01081-9777 |
Second Address | Springfield, MA 01108-2024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |