Provider Demographics
NPI:1578624581
Name:BAZIN, WILLIAM R (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:BAZIN
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 1:200 N MAIN ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-2392
Mailing Address - Country:US
Mailing Address - Phone:413-525-2932
Mailing Address - Fax:413-525-6839
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2392
Practice Address - Country:US
Practice Address - Phone:413-525-2932
Practice Address - Fax:413-525-6839
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA1052OtherLICENSE
MAY35719Medicare ID - Type UnspecifiedPROVIDER
MAT58350Medicare UPIN
MAY49183Medicare ID - Type UnspecifiedGROUP