Provider Demographics
NPI:1326113374
Name:LEVIN, MINDY (DC)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:LEVIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-4381
Mailing Address - Country:US
Mailing Address - Phone:508-325-4777
Mailing Address - Fax:508-228-7024
Practice Address - Street 1:4 BARTLETT RD
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-4381
Practice Address - Country:US
Practice Address - Phone:508-325-4777
Practice Address - Fax:508-228-7024
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36074OtherBLUE CROSS BLUE SHEILD
MA0008946Medicare PIN
MAU01280Medicare UPIN
MAY36074OtherBLUE CROSS BLUE SHEILD