Provider Demographics
NPI:1457450157
Name:MUGAVERO, RICHARD A (DC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:MUGAVERO
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 1:5A S CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7411
Mailing Address - Country:US
Mailing Address - Phone:978-521-7111
Mailing Address - Fax:
Practice Address - Street 1:5A S CENTRAL ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-7411
Practice Address - Country:US
Practice Address - Phone:978-521-7111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2651111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0145736001OtherCIGNA HEALTHCARE
NH05Y003955MA01OtherANTHEM
MA464731OtherTUFTS HEALTH PLAN
MA2719698OtherAETNA/US HEALTHCARE
NH642490OtherHEALTHSOURCE
MAY36845OtherBLUECROSS BLUESHIELD
MA2180329OtherUNITED HEALTHCARE
MAY45493Medicare ID - Type UnspecifiedPROVIDER NUMBER