Provider Demographics
NPI:1588852768
Name:DAVID EAGAN PC
Entity Type:Organization
Organization Name:DAVID EAGAN PC
Other - Org Name:BROADWAY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:EAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:781-599-8826
Mailing Address - Street 1:30 BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2540
Mailing Address - Country:US
Mailing Address - Phone:781-599-8826
Mailing Address - Fax:781-596-2156
Practice Address - Street 1:30 BOSTON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2540
Practice Address - Country:US
Practice Address - Phone:781-599-8826
Practice Address - Fax:781-596-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA467545OtherTUFTS HEALTH PLAN
MA2453050OtherAETNA
MA6399335OtherCIGNA
MAAA34472OtherHARVARD PILGRIM
MA661194OtherUNITED HEALTH CARE
MAY36758OtherBLUE CROSS BLUE SHIELD
MAY45413Medicare UPIN