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Individual

DOUGLAS JOSEPH GENDRON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DC

Contact information

Practice address
438 CHESTNUT ST, SPRINGFIELD, MA 01107
(413) 746-0504
(413) 746-0508
Mailing address
438 CHESTNUT ST, SPRINGFIELD, MA 01107
(413) 746-0504
(413) 746-0508

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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