Provider Demographics
NPI:1669574349
Name:BERUBE, JEFFREY NEIL (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:NEIL
Last Name:BERUBE
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 1:352 PARK ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NORTH READING
Mailing Address - State:MA
Mailing Address - Zip Code:01864-2164
Mailing Address - Country:US
Mailing Address - Phone:978-664-0610
Mailing Address - Fax:978-664-0723
Practice Address - Street 1:203 A MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORTH READING
Practice Address - State:MA
Practice Address - Zip Code:01864
Practice Address - Country:US
Practice Address - Phone:978-664-0610
Practice Address - Fax:978-664-0723
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH2018111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1613863Medicaid
MAY45315Medicare ID - Type Unspecified