Provider Demographics
NPI:1417063421
Name:ROBICHAUD, JEFFREY M (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:ROBICHAUD
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 1:22 TOBIN DR
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-2164
Mailing Address - Country:US
Mailing Address - Phone:978-369-2266
Mailing Address - Fax:978-369-5205
Practice Address - Street 1:56 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2076
Practice Address - Country:US
Practice Address - Phone:978-369-2266
Practice Address - Fax:978-369-5205
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA730539OtherTUFTS HEALTH PLANS
MA351105OtherHCHP PLANS
MA351105OtherHCHP PLANS