Provider Demographics
NPI:1902070121
Name:GANGEMI CHIROPRACTIC PC
Entity Type:Organization
Organization Name:GANGEMI CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GANGEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-344-8878
Mailing Address - Street 1:294 PLEASANT ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2571
Mailing Address - Country:US
Mailing Address - Phone:781-344-8878
Mailing Address - Fax:781-344-0642
Practice Address - Street 1:294 PLEASANT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2571
Practice Address - Country:US
Practice Address - Phone:781-344-8878
Practice Address - Fax:781-344-0642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1720105075Medicare NSC