Provider Demographics
NPI:1336298637
Name:WEXLER, KEVIN GRANT (DC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:GRANT
Last Name:WEXLER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-3377
Mailing Address - Country:US
Mailing Address - Phone:978-988-2225
Mailing Address - Fax:978-988-0935
Practice Address - Street 1:668 MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-3377
Practice Address - Country:US
Practice Address - Phone:978-988-2225
Practice Address - Fax:978-988-0935
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1612336Medicaid
MAY45175Medicare ID - Type Unspecified
MA1612336Medicaid