Provider Demographics
NPI:1649338351
Name:DIAMOND, BARRY (DC)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:DIAMOND
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 1:811 LIBERTY SQUARE RD
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719-1114
Mailing Address - Country:US
Mailing Address - Phone:978-263-5182
Mailing Address - Fax:
Practice Address - Street 1:274 GREAT RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4702
Practice Address - Country:US
Practice Address - Phone:978-263-5182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA676911OtherCIGNA PROVIDER NUMBER
MA1600630Medicaid
MA464807OtherTUFTS ID #
MA3116790OtherATENA PROVIDER NUMBER
MAY36903OtherBLUE CROSS OF MA PROVIDER
MAAA10990OtherHARVARD PILGRIM ID #
MAAA10990OtherHARVARD PILGRIM ID #