Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 1905 | MA |
NPI | 1265653612 |
---|---|
Provider Name | Dr. Michael Joseph Dimauro |
First Address | Lawrence, MA 01843-2631 |
Second Address | Lawrence, MA 01843-2631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |