Provider Demographics
NPI:1295721660
Name:BRONSTEIN, LAWRENCE (DC CNS DACBN)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:BRONSTEIN
Suffix:
Gender:M
Credentials:DC CNS DACBN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MAHAIWE ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1901
Mailing Address - Country:US
Mailing Address - Phone:413-528-2948
Mailing Address - Fax:413-528-5404
Practice Address - Street 1:15 MAHAIWE ST
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1901
Practice Address - Country:US
Practice Address - Phone:413-528-2948
Practice Address - Fax:413-528-5404
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
351202OtherHARVARD PILGRIM
MAY36159Medicaid
351202OtherHARVARD PILGRIM