Provider Demographics
NPI:1275539827
Name:IERONIMO, RAYMOND M (DC)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:M
Last Name:IERONIMO
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 1:222 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7352
Mailing Address - Country:US
Mailing Address - Phone:978-373-6030
Mailing Address - Fax:
Practice Address - Street 1:222 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-7352
Practice Address - Country:US
Practice Address - Phone:978-373-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35676Medicare ID - Type Unspecified