Provider Demographics
NPI:1649350364
Name:TANGUAY, DAVE B (DC)
Entity type:Individual
Prefix:
First Name:DAVE
Middle Name:B
Last Name:TANGUAY
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 1:140 PARK ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-3064
Mailing Address - Country:US
Mailing Address - Phone:508-348-4091
Mailing Address - Fax:508-222-4595
Practice Address - Street 1:140 PARK ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3064
Practice Address - Country:US
Practice Address - Phone:508-348-4091
Practice Address - Fax:508-222-4595
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY39873OtherBCBSMA
670954OtherUNITED HEALTH
RI29932-7OtherBCBSRI
RI405617OtherBLUE CHIP
RI405617OtherBLUE CHIP
MAY35628Medicare ID - Type Unspecified