Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 1909 | MA |
NPI | 1588754378 |
---|---|
Provider Name | Dr. Mark Stephen Tierney |
First Address | Reading, MA 01867-2018 |
Second Address | Reading, MA 01867-3616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 16/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1611461 | (05) | MA |
U56576 | (02) | MA |