Provider Demographics
NPI:1346232550
Name:D'AGOSTINO, DESIREE KIEHN (DC)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:KIEHN
Last Name:D'AGOSTINO
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 1:651 BOYLSTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2846
Mailing Address - Country:US
Mailing Address - Phone:617-859-9500
Mailing Address - Fax:617-859-9595
Practice Address - Street 1:651 BOYLSTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2846
Practice Address - Country:US
Practice Address - Phone:617-859-9500
Practice Address - Fax:617-859-9595
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1610635Medicaid
MAY36309Medicare ID - Type Unspecified
MA1610635Medicaid