Provider Demographics
NPI:1215069745
Name:TATE, DONALD EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EDWARD
Last Name:TATE
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 1:45 GLENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-2009
Mailing Address - Country:US
Mailing Address - Phone:781-275-4736
Mailing Address - Fax:
Practice Address - Street 1:50 MALL ROAD
Practice Address - Street 2:SUITE G-12
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803
Practice Address - Country:US
Practice Address - Phone:781-272-5200
Practice Address - Fax:781-272-5260
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1602098Medicaid
MA1602098Medicaid