Provider Demographics
NPI:1043395577
Name:GLADSTONE, DAVID MILES (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MILES
Last Name:GLADSTONE
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 1:1855 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2426
Mailing Address - Country:US
Mailing Address - Phone:617-533-8902
Mailing Address - Fax:617-533-7814
Practice Address - Street 1:1855 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-2426
Practice Address - Country:US
Practice Address - Phone:617-533-8902
Practice Address - Fax:617-533-7814
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3613111N00000X
FLCH10173111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation