Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 1492 | MA |
NPI | 1225107360 |
---|---|
Provider Name | Mr. Fredrick H. Chassman |
First Address | Bow, NH 03304-4310 |
Second Address | Worcester, MA 01605-2501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1610856 | (05) | MA |
CHY36090 | BLUE CROSS BLUE SHIELD (01) | MA |