Provider Demographics
NPI:1619032372
Name:PACKER, EUGENE LESLIE (DC)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:LESLIE
Last Name:PACKER
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 1:111 WASHINGTON ST
Mailing Address - Street 2:PO BOX 369
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1127
Mailing Address - Country:US
Mailing Address - Phone:508-238-0183
Mailing Address - Fax:508-238-3885
Practice Address - Street 1:111 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1127
Practice Address - Country:US
Practice Address - Phone:508-238-0183
Practice Address - Fax:508-238-3885
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35052OtherBLUE CROSS & BLUE SHIELD
MAY39363OtherBLUE CROSS & BLUE SHIELD
MAAA135580OtherHARVARD PILIGRIM
MA711961OtherTUFTS
MAAA135580OtherHARVARD PILIGRIM
MAY39363OtherBLUE CROSS & BLUE SHIELD