Provider Demographics
NPI:1427459247
Name:BRIGOCKAS, CHAD R (LAC)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:R
Last Name:BRIGOCKAS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 JOYCE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1608
Mailing Address - Country:US
Mailing Address - Phone:347-276-3373
Mailing Address - Fax:
Practice Address - Street 1:36 JOYCE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1608
Practice Address - Country:US
Practice Address - Phone:347-276-3373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005422171100000X
MA278671171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty