Provider Demographics
NPI:1598884066
Name:MAHER, BRIAN J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:MAHER
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 1:555 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2932
Mailing Address - Country:US
Mailing Address - Phone:508-845-2778
Mailing Address - Fax:
Practice Address - Street 1:555 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2932
Practice Address - Country:US
Practice Address - Phone:508-845-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2315111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45723Medicare ID - Type Unspecified