Provider Demographics
NPI:1043488992
Name:FAHEY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:FAHEY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:FAHEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-447-7100
Mailing Address - Street 1:549 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-1875
Mailing Address - Country:US
Mailing Address - Phone:781-447-7100
Mailing Address - Fax:781-447-7117
Practice Address - Street 1:549 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382-1875
Practice Address - Country:US
Practice Address - Phone:781-447-7100
Practice Address - Fax:781-447-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39551OtherBCBS OF MA
MA461056OtherTUFTS
MAU68533OtherHARVARD PILGRIM
MAY39551OtherBCBS OF MA
MAU68533Medicare UPIN