Provider Demographics
NPI:1053303354
Name:GAUTHIER, LEONARD J (DC)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:J
Last Name:GAUTHIER
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 1:72 SOHIER RD
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2654
Mailing Address - Country:US
Mailing Address - Phone:978-927-5880
Mailing Address - Fax:978-927-8309
Practice Address - Street 1:72 SOHIER RD
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2654
Practice Address - Country:US
Practice Address - Phone:978-927-5880
Practice Address - Fax:978-927-8309
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT57957Medicare UPIN
MAY35026Medicare ID - Type Unspecified