Provider Demographics
NPI:1225107360
Name:CHASSMAN, FREDRICK H (DC)
Entity Type:Individual
Prefix:MR
First Name:FREDRICK
Middle Name:H
Last Name:CHASSMAN
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 1:8 OGDEN DR
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-4310
Mailing Address - Country:US
Mailing Address - Phone:508-795-1555
Mailing Address - Fax:508-755-4464
Practice Address - Street 1:192 LINCOLN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2501
Practice Address - Country:US
Practice Address - Phone:508-795-1555
Practice Address - Fax:508-755-4464
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1492111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1610856Medicaid
MACHY36090OtherBLUE CROSS BLUE SHIELD
MA1610856Medicaid