Provider Demographics
NPI:1194739573
Name:PENDOLINO, MICHAEL TODD (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TODD
Last Name:PENDOLINO
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 1:20 CUMMINGS PARK
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801
Mailing Address - Country:US
Mailing Address - Phone:781-938-9400
Mailing Address - Fax:781-938-9323
Practice Address - Street 1:20 CUMMINGS PARK
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:781-938-9400
Practice Address - Fax:781-938-9323
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2611483OtherAETNA
460083OtherTUFTS
AA7544OtherHARVARD PILGRIM
Y39772OtherBLUE CROSS BLUE SHIELD
MA1697021Medicaid
AA7544OtherHARVARD PILGRIM
460083OtherTUFTS