Provider Demographics
NPI:1720105075
Name:GANGEMI, DAMON J (DC)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:J
Last Name:GANGEMI
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 1:294 PLEASANT ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2571
Mailing Address - Country:US
Mailing Address - Phone:784-344-8878
Mailing Address - Fax:781-344-0642
Practice Address - Street 1:294 PLEASANT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2571
Practice Address - Country:US
Practice Address - Phone:784-344-8878
Practice Address - Fax:781-344-0642
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGAY36341Medicare ID - Type Unspecified