Provider Demographics
NPI:1669473997
Name:FANSELOW, DANIEL JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:FANSELOW
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 1:6 COLONIAL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WESTBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1407
Mailing Address - Country:US
Mailing Address - Phone:508-366-3333
Mailing Address - Fax:508-366-3860
Practice Address - Street 1:6 COLONIAL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WESTBORO
Practice Address - State:MA
Practice Address - Zip Code:01581-1407
Practice Address - Country:US
Practice Address - Phone:508-366-3333
Practice Address - Fax:508-366-3860
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1420111NN0400X
CT000803111NN0400X
NYX005816111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA210554OtherAMERICAN SPECIALTY HEALTH
MA14312OtherFALLON
MA546258OtherUS HEALTH CARE
MA9903976Medicaid
MAW200631OtherCIGNA
MA42083126OtherAETNA
MA4400279OtherUNITED HEALTHCARE
MA739970OtherTUFTS
MA043255443OtherTAX ID
MA35251OtherHARVARD PILGRIM HEALTHCAR
MA59090OtherFIRST HEALTH/HCVM
MAFAY35984OtherBLUE CROSS BLUE SHIELD
MA210554OtherAMERICAN SPECIALTY HEALTH
MAW200631OtherCIGNA