Individual
DR. KATHLEEN M FAVALORO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CHIROPRACTOR, PT
Contact information
Practice address
19 LEWIS AVENUE, GREAT BARRINGTON, MA 01230
(413) 528-5535
Mailing address
PO BOX 12, GREAT BARRINGTON, MA 01230-0012
(413) 528-5535
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2395
MA
111N00000X
Chiropractor
X009242-1
NY
225100000X
Physical Therapist
006800-1
NY
225100000X
Physical Therapist
12166
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q04313
DC BCBS
—
01
—
Q04314
PT BCBS
—
Enumeration date
11/17/2006
Last updated
08/11/2015
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