Provider Demographics
NPI:1184676553
Name:GIAMMATTEO, THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:GIAMMATTEO
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 1:66 UNION SQ
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3040
Mailing Address - Country:US
Mailing Address - Phone:617-666-9600
Mailing Address - Fax:617-666-9601
Practice Address - Street 1:66 UNION SQ
Practice Address - Street 2:SUITE 204
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3040
Practice Address - Country:US
Practice Address - Phone:617-666-9600
Practice Address - Fax:617-666-9601
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1724111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA42-1608651OtherEIN