Provider Demographics
NPI:1790827863
Name:COULOMBE, BRUCE JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JOSEPH
Last Name:COULOMBE
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 1:601 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2037
Mailing Address - Country:US
Mailing Address - Phone:413-534-7200
Mailing Address - Fax:413-534-7201
Practice Address - Street 1:601 NEWTON ST
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-2037
Practice Address - Country:US
Practice Address - Phone:413-534-7200
Practice Address - Fax:413-534-7201
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36270Medicare ID - Type Unspecified