Provider Demographics
NPI:1154425783
Name:CUSA OF DANVERS PC
Entity type:Organization
Organization Name:CUSA OF DANVERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:G
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:978-646-0010
Mailing Address - Street 1:49 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-2320
Mailing Address - Country:US
Mailing Address - Phone:781-598-4161
Mailing Address - Fax:
Practice Address - Street 1:47 ELM ST
Practice Address - Street 2:#3
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2835
Practice Address - Country:US
Practice Address - Phone:978-646-0010
Practice Address - Fax:978-646-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT58296Medicare UPIN
MAOBY35625Medicare ID - Type Unspecified