Provider Demographics
NPI:1265506679
Name:DRISCOLL, STEPHEN M (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:DRISCOLL
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 1:153 LOVELLS LANE
Mailing Address - Street 2:
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648
Mailing Address - Country:US
Mailing Address - Phone:508-420-1160
Mailing Address - Fax:508-420-3245
Practice Address - Street 1:153 LOVELLS LANE
Practice Address - Street 2:
Practice Address - City:MARSTONS MILLS
Practice Address - State:MA
Practice Address - Zip Code:02648
Practice Address - Country:US
Practice Address - Phone:508-420-1160
Practice Address - Fax:508-420-3245
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35835Medicare ID - Type Unspecified