Provider Demographics
NPI:1770644999
Name:SHAMATTA, JOSEPH P (BA, DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:SHAMATTA
Suffix:
Gender:M
Credentials:BA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3326
Mailing Address - Country:US
Mailing Address - Phone:508-580-2225
Mailing Address - Fax:
Practice Address - Street 1:605 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3326
Practice Address - Country:US
Practice Address - Phone:508-580-2225
Practice Address - Fax:508-580-8898
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA12914OtherHPHC NO.
MAAA12914OtherHPHC NO.
MAU47037Medicare UPIN