Provider Demographics
NPI:1467730317
Name:FIELDGATE, DAVID JOHN (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:FIELDGATE
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 1:101 BROADWAY RD
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4068
Mailing Address - Country:US
Mailing Address - Phone:978-970-2222
Mailing Address - Fax:978-970-3643
Practice Address - Street 1:101 BROADWAY RD
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-4068
Practice Address - Country:US
Practice Address - Phone:978-970-2222
Practice Address - Fax:978-970-3643
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor