Provider Demographics
NPI:1396711255
Name:HIRSCH, BRUCE S (DO)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:S
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1280 CENTRE ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1553
Mailing Address - Country:US
Mailing Address - Phone:617-641-9999
Mailing Address - Fax:617-641-6767
Practice Address - Street 1:1280 CENTRE ST
Practice Address - Street 2:SUITE 210
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-1553
Practice Address - Country:US
Practice Address - Phone:617-641-9999
Practice Address - Fax:617-641-6767
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA598111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T58175Medicare UPIN
MAY45356Medicare ID - Type Unspecified