Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH652 | MA |
N | 111NN0400X | Neurology | CH652 | MA |
NPI | 1790974749 |
---|---|
Provider Name | Dr. Mark Anthony Davini |
First Address | Boston, MA 02114-2124 |
Second Address | S Yarmouth, MA 02664-5254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2007 |
Last Update Date | 17/03/2018 |