Provider Demographics
NPI:1639291362
Name:EAGAN, DAVID BOYD (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BOYD
Last Name:EAGAN
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 1:30 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2527111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA661194OtherUNITED HEALTH PROVIDER #
MA2453050OtherAETNA PROVIDER #
MA6399335OtherCIGNA PROVIDER #
MA467545OtherTUFTTS PROVIDER #
MA1696777OtherMASSHEALTH PROVIDER #
MAAA34472OtherHARVARD PROVIDER #
MAAA34472OtherHARVARD PROVIDER #
MA043538015Medicare UPIN