Provider Demographics
NPI:1821525510
Name:DAGENAIS, SIMON (DC)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:DAGENAIS
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 1:94 HILLCREST PKWY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1440
Mailing Address - Country:US
Mailing Address - Phone:781-460-3002
Mailing Address - Fax:
Practice Address - Street 1:94 HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1440
Practice Address - Country:US
Practice Address - Phone:781-460-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor