Provider Demographics
NPI:1578504122
Name:DANIELS, BRIAN PERRY (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:PERRY
Last Name:DANIELS
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 1:363 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4000
Mailing Address - Country:US
Mailing Address - Phone:781-676-0008
Mailing Address - Fax:781-676-0014
Practice Address - Street 1:363 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4000
Practice Address - Country:US
Practice Address - Phone:781-676-0008
Practice Address - Fax:781-676-0014
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH2268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA400818OtherTUFTS HEALTH PLAN CHIRO
MAAA28750OtherHARVARD PILGRIM HEALTH
MAY36617OtherBLUECROSSBLUESHIELD CHIRO
MAAA28750OtherHARVARD PILGRIM HEALTH
MAY45219Medicare PIN