Organization
PARK STREET CHIROPRACTIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN C FAHEY DC (PRESIDENT)
(781) 341-0900
Entity
Organization
Contact information
Practice address
1256 PARK ST, SUITE 205, STOUGHTON, MA 02072-3745
(781) 341-0900
Mailing address
1256 PARK ST, SUITE 205, STOUGHTON, MA 02072-3745
(781) 341-0900
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
MA 2213
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
461056
TUFTS
MA
01
—
U68533
HARVARD PILGRIM
—
01
—
Y39551
BC/BS OF MA.
MA
Enumeration date
09/22/2010
Last updated
09/22/2010
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