Provider Demographics
NPI:1285711606
Name:DJERASSI, BORIS DOV (DC)
Entity type:Individual
Prefix:DR
First Name:BORIS
Middle Name:DOV
Last Name:DJERASSI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BORIS
Other - Middle Name:DOV
Other - Last Name:DJERASSI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:129 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1151
Mailing Address - Country:US
Mailing Address - Phone:508-672-0158
Mailing Address - Fax:508-730-1223
Practice Address - Street 1:400 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3034
Practice Address - Country:US
Practice Address - Phone:508-677-2222
Practice Address - Fax:508-730-1223
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA352327OtherHARVARD PILGRIM - MA. ID#
MA667631OtherACN GROUP US HELATHCARE
MAY36409OtherBLUE CROSS - MA. ID #
RI7267-8OtherBLUE CROSS - RI. ID #
RI409082OtherBLUE CHIP - RI. ID #
MA352327OtherHARVARD PILGRIM - MA. ID#
RI409082OtherBLUE CHIP - RI. ID #
MA1604350Medicare ID - Type UnspecifiedMASS. HEALTH ID #