Provider Demographics
NPI:1265599328
Name:LUSTGARTEN, ERIC (DC)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:LUSTGARTEN
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 1:655 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-3717
Mailing Address - Country:US
Mailing Address - Phone:508-668-8900
Mailing Address - Fax:508-668-8901
Practice Address - Street 1:655 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-3717
Practice Address - Country:US
Practice Address - Phone:508-668-8900
Practice Address - Fax:508-668-8901
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1429111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALUY36125Medicare ID - Type Unspecified