Provider Demographics
NPI:1114026713
Name:PIASECKI, WALTER M (DC)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:M
Last Name:PIASECKI
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 1:1 WEST UNION STREET
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01721
Mailing Address - Country:US
Mailing Address - Phone:508-881-4443
Mailing Address - Fax:
Practice Address - Street 1:1 WEST UNION STREET
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MA
Practice Address - Zip Code:01721
Practice Address - Country:US
Practice Address - Phone:508-881-4443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH628111N00000X
FLCH3594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA687770OtherCIGNA HMO
MA1612832Medicaid
MA781715OtherAETNA HMO
MAY35473OtherBLUE CROSS BLUE SHIELD
MA35570OtherHARVARD PILGRIM
MA703955OtherTUFTS
Y35473Medicare ID - Type Unspecified