Provider Demographics
NPI:1689651598
Name:CASTILLO, DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:CASTILLO
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 1:87 SWAN ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5048
Mailing Address - Country:US
Mailing Address - Phone:978-379-0190
Mailing Address - Fax:978-379-0192
Practice Address - Street 1:87 SWAN ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5048
Practice Address - Country:US
Practice Address - Phone:978-379-0190
Practice Address - Fax:978-379-0192
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY37028OtherBCBS
MACA945570Medicare PIN
NHU92317Medicare UPIN