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Individual
DOUGLAS JOSEPH GENDRON
Active
Individual
DOUGLAS JOSEPH GENDRON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2005
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1028952
FALLON
—
01
—
1601229
MASS HEALTH MEDICAID
—
05
—
1601229
—
MA
01
—
3065316
AETNA
—
01
—
665295
ACN GROUP
—
01
—
Y36679
BCBS
MA
01
—
Y36679
BCBS MASS INDEMNITY
—
01
—
Y45483
MEDICARE MASS AREA 99
—
Enumeration date
08/19/2006
Last updated
07/08/2007
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