Provider Demographics
NPI:1548276629
Name:CONNORS, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CONNORS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3350
Mailing Address - Country:US
Mailing Address - Phone:781-436-5006
Mailing Address - Fax:781-436-8197
Practice Address - Street 1:1935 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3350
Practice Address - Country:US
Practice Address - Phone:781-436-5006
Practice Address - Fax:781-436-8197
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH 945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35648Medicare ID - Type Unspecified