Provider Demographics
NPI:1578669008
Name:FEDER, LAUREL (DC)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:FEDER
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 1:51 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-5791
Mailing Address - Country:US
Mailing Address - Phone:978-281-5131
Mailing Address - Fax:978-290-4344
Practice Address - Street 1:51 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-5791
Practice Address - Country:US
Practice Address - Phone:978-281-5131
Practice Address - Fax:978-290-4344
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y36086OtherBCBS
351966OtherHARVARD PILGRIM
MA725127OtherTUFTS HEALTH PLAN
MAY36086OtherBCBS
MA351966OtherHARVARD PILGRIM
Y36086OtherBCBS