Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | DCP00600 | RI |
N | 111NR0400X | Rehabilitation Chiropractor | 3646 | MA |
N | 111NR0400X | Rehabilitation Chiropractor | DCP00600 | RI |
Y | 111NS0005X | Chiropractic Sports Physician | 3646 | MA |
N | 111NS0005X | Chiropractic Sports Physician | DCP00600 | RI |
NPI | 1023348703 |
---|---|
Provider Name | Dr. Michael Jean Pepin |
First Address | Cumberland, RI 02864-2213 |
Second Address | Attleboro Falls, MA 02763-1100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2010 |
Last Update Date | 01/03/2021 |