Provider Demographics
NPI:1114041480
Name:FAHEY, BRIAN CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:FAHEY
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 1:1256 PARK ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3745
Mailing Address - Country:US
Mailing Address - Phone:781-341-6000
Mailing Address - Fax:781-297-5723
Practice Address - Street 1:1256 PARK ST
Practice Address - Street 2:SUITE 205
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3745
Practice Address - Country:US
Practice Address - Phone:781-341-6000
Practice Address - Fax:781-297-5723
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA461056OtherTUFTS
MAU68533OtherHARVARD PILGRIM
MAY39551OtherBCBS OF MA.
MA461056OtherTUFTS
MAY45155Medicare ID - Type UnspecifiedPROVIDER ID#