Provider Demographics
NPI:1003064072
Name:MAYER, JOHN J (LIC AC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:MAYER
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 COLRAIN RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-9763
Mailing Address - Country:US
Mailing Address - Phone:413-475-3428
Mailing Address - Fax:
Practice Address - Street 1:833 COLRAIN RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-9763
Practice Address - Country:US
Practice Address - Phone:413-475-3428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA677171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist