Provider Demographics
NPI:1205810645
Name:BAGSHAW, DAVID S
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:BAGSHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SYCAMORE LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2314
Mailing Address - Country:US
Mailing Address - Phone:631-543-6777
Mailing Address - Fax:631-543-1875
Practice Address - Street 1:28 SYCAMORE LN
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2314
Practice Address - Country:US
Practice Address - Phone:631-543-6777
Practice Address - Fax:631-543-1875
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4000-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X22331Medicare UPIN