Provider Demographics
NPI:1104935790
Name:AMATO, CHARLEEN DAWN (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLEEN
Middle Name:DAWN
Last Name:AMATO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 JANICE RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-1517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:175 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-2930
Practice Address - Country:US
Practice Address - Phone:781-221-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA 2387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2302636OtherAETNA
MAB20951101OtherCIGNA
MA1696718OtherMASSHEALTH
MA352491OtherHARVARD PILGRIM
MAY36697OtherBLUE CROSS/BLUE SHIELD
MAY45349Medicare ID - Type Unspecified