Provider Demographics
NPI:1487867420
Name:DORICENT, LYNDA (DC)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:
Last Name:DORICENT
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 1:52 MORRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2309
Mailing Address - Country:US
Mailing Address - Phone:617-872-2140
Mailing Address - Fax:
Practice Address - Street 1:690 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144
Practice Address - Country:US
Practice Address - Phone:617-629-2600
Practice Address - Fax:617-666-9302
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3235926OtherAETNA
MA414532OtherTUFTS
MA1604601Medicaid
MA352433OtherHARVARD PILGRIM
MA3790901OtherCIGNA
MAY36947OtherBCBS
MAY45556Medicare ID - Type UnspecifiedMEDICARE B
MAU91506Medicare UPIN