Provider Demographics
NPI:1861539082
Name:DOHERTY, PAUL JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAMES
Last Name:DOHERTY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 NILES ST
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-2408
Mailing Address - Country:US
Mailing Address - Phone:781-878-2340
Mailing Address - Fax:781-878-6115
Practice Address - Street 1:945 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351-1202
Practice Address - Country:US
Practice Address - Phone:781-878-2801
Practice Address - Fax:781-878-6115
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1047111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADOY35717Medicare UPIN
MADOY45390Medicare ID - Type Unspecified